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Updated: Sep 8, 2026
Modified Radical Neck Dissection for Cervical Metastasis
Published on: February 20, 2026
Level IA Nodal Involvement in Parotid Cutaneous Squamous Cell Carcinoma
Gideon R Budiono1, Rahul Jayakar1, Jonas Werner1
1Department of Head and Neck Surgery, Chris O'Brien Lifehouse, Sydney, Australia.
Background:
The frequency of Level IA metastasis in advanced cutaneous squamous cell carcinoma (cSCC) remains undefined yet determines the oncological safety of submental island flap (SIF) reconstruction.
Methods:
A retrospective cohort study was performed on 131 adults who underwent parotidectomy and neck dissection, identified from the Sydney Head and Neck Cancer Institute database (2000-2025): 110 with parotid metastases and 21 with preauricular cSCC. The primary outcome was pathological Level IA involvement.
Results:
Level IA involvement was identified in 4 patients (3.6%; 95% CI, 1%-9%), with an occult rate of 0% (95% CI, 0%-3.3%). This was significantly associated with extent of neck dissection, pathological nodal status and median nodal burden (all p ≤ 0.02).
Conclusions:
Level IA metastasis is uncommon in advanced cSCC and occurs exclusively in high-burden nodal disease. These findings support selective omission of Level IA dissection in the clinically node-negative neck and the oncological safety of SIF in well-selected patients.
