Total Parotidectomy Recommended for Metastatic Head and Neck Skin Cancer

Frequency of parotid deep lobe and neck metastasis in patients with cutaneous squamous cell carcinoma and malignant melanoma leads to total parotidectomy recommendation

medwireNews: Patients with cutaneous Squamous cell carcinoma (CSCC) or malignant melanoma (MM) in the parotid superficial lobe should be considered for deep lobe parotidectomy, suggest researchers.

Their recommendation is based on the finding that lymph nodes in the parotid deep lobe and neck are affected in a significant number of these patients.

Among 65 patients with pathologically confirmed cSCC or MM following superficial parotidectomy, deep lobe parotidectomy and neck dissection showed metastasis to the deep lobes in 22% and to the cervical lymph nodes in 29%.

“Metastatic spread to the parotid deep lobe and neck occurred at similar frequencies and often occurred together, with both representing a more advanced and aggressive cancer”, say the researchers, led by Kerry Olsen, from Mayo Clinic Medical School in Rochester, Minnesota, USA.

They add: “Removing the parotid deep lobe and treating with adjuvant therapy leads to a lower rate of parotid-area local recurrence compared with other series in which the parotid deep lobe is not routinely removed but rather the parotid superficial lobe is routinely removed and then treated with adjuvant therapy.”

The rate of deep lobe metastasis was 26% for the 42 patients with cSCC and 13% for the 23 patients with MM, while the respective rates of cervical lymph node metastasis were 31% and 26%.

Patients with cSCC were significantly more likely to have metastatic spread to the deep lobe if they had neck metastasis and N2 stage disease versus N0, at odd ratios of 4.10 and 4.80, respectively.

The researchers note in JAMA Otolaryngology Head and Neck Surgery that total parotidectomy resulted in “excellent” parotid-area local control, at 93% for patients with cSCC and 100% for patients with MM. And 5-year local control rates were similar for cSCC patients with and without deep lobe metastasis, at 89% and 92%, respectively.

But deep lobe metastasis was a significant risk factor for poor outcomes among patients with cSCC, increasing the risk of distant metastasis 5.4-fold, disease recurrence 3.5-fold and death from all causes 2.9-fold.

“The presence of parotid deep lobe metastasis remains a harbinger of increased risk of distant disease and poor outcomes, and this new information is useful in treatment planning and in counseling patients and physicians”, the team concludes.


Thom JJ, Moore EJ, Price DL, et al. The role of total parotidectomy for metastatic cutaneous squamous cell carcinoma and malignant melanoma. JAMA Otolaryngol Head Neck Surg 2014; Advance online publication April 10. doi: 10.1001/jamaoto.2014.352

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