Metastatic cutaneous squamous cell carcinoma to the parotid and cervical lymph nodes: treatment and outcomes

The role of parotidectomy and neck dissection in the management of cutaneous squamous cell carcinoma (SCC) of the head and neck is not as well defined as the role in operations of upper aerodigestive tract and salivary glands. The purpose of this article is to review the current literature regarding head and neck cutaneous SCC with respect to implications of parotid and cervical metastasis.

A subset of head and neck cutaneous SCCs are aggressive. Parotid and cervical nodal involvement represents a poor prognosis. Assessment of nodal and parotid involvement allows the surgeon to identify patients at risk for locoregional recurrence and poor survival. Overexpression of the epidermal growth factor receptor is present in patients with lymphatic metastasis. Surgical treatment is expanding, to include a spectrum ranging from sentinel lymph node biopsy to lymphoscintigraphy-specific lymphadenectomy in clinically negative necks. In addition to established cervical nodal basins of levels I-VI, parotid, buccal, and external jugular basins are relevant in managing these patients. Application of radiation therapy in an adjuvant setting provides enhanced local regional control in patients with positive parotid and neck nodes.

The identification of 'high-risk' patients with head and neck cutaneous SCC is imperative to improve patient outcome. Surgical management of the parotid and neck are important aspects of management of the high-risk patient. Application of radiation in the adjuvant setting improves locoregional disease control for patients with positive parotid and cervical nodes. Enhanced understanding of epidermal growth factor receptor may allow for improved therapeutic strategies.