Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of the head and neck region

Braz J Otorhinolaryngol. 2022 Nov-Dec;88 Suppl 4(Suppl 4):S152-S162. doi: 10.1016/j.bjorl.2021.11.007. Epub 2021 Dec 10.

Abstract

Objective: To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed Cutaneous Squamous Cell Carcinoma (CSCC) of the head and neck region.

Methods: Single-center retrospective cohort study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: Overall Survival (OS) and Disease-Specific Survival (DSS).

Results: The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR = 37.6 of positive parotid metastasis evolving into positive neck metastasis, p = 0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 versus T1, p = 0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p = 0.016; OS and DSS showed negative survival for the parotid metastasis group, p = 0.0283.

Conclusion: Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat these patients with advanced CSCC of the head and neck region.

Level of evidence: II b - Retrospective Cohort Study - Oxford Centre for Evidence-Based Medicine (OCEBM).

Keywords: Parotid neoplasms; Prognosis; Salivary gland diseases; Skin neoplasms; Survival analysis.

MeSH terms

  • Aged
  • Carcinoma, Squamous Cell* / pathology
  • Female
  • Head and Neck Neoplasms* / pathology
  • Head and Neck Neoplasms* / surgery
  • Humans
  • Male
  • Neck Dissection
  • Neoplasm Recurrence, Local / surgery
  • Neoplasm Staging
  • Parotid Neoplasms* / pathology
  • Parotid Neoplasms* / surgery
  • Retrospective Studies
  • Skin Neoplasms* / pathology
  • Skin Neoplasms* / surgery
  • Squamous Cell Carcinoma of Head and Neck / pathology
  • Squamous Cell Carcinoma of Head and Neck / surgery