Analysis and Review of Outcomes for Cutaneous Squamous Cell Carcinoma Involving the Parotid

Abstract

Objectives:

An in depth analysis of outcomes following parotidectomy for a cutaneous squamous cell carcinoma.

Methods:

Retrospective review (2003-2012).

Results:

Forty-nine percent of 218 patients presented with a primary lesion (n = 107), and 51% presented with a recurrence (n = 111). Parotid lymph nodes were positive in 52% of patients; 81% had a concurrent neck dissection, and 28% had cervical lymph node metastases. Eighteen percent had both positive parotid and cervical lymph nodes. The majority of margins were negative (49%), with 19% being < 2mm. Preoperative radiation therapy did not decrease the incidence of cervical (P = 0.27) or parotid (P = 0.37) lymph node involvement, perineural invasion (P = 0.08), positive margins (P = 0.31), facial nerve sacrifice (P = 0.43), or rate of recurrence (P = 0.87). The overall 2- and 5-year survival rates were 0.71 and 0.58. Overall 5-year survival was lower for patients presenting with recurrent (0.49) vs. primary disease (0.69; P = 0.04). In addition, decreased overall 5-year survival rates were associated with cervical lymph involvement (0.47 vs. 0.62; P = 0.01) and preoperative radiation therapy (0.39 vs. 0.67; P = 0.037). Interestingly, there was no difference in overall survival when stratified by parotid lymph node involvement (P = 0.85), margin status (P = 0.67), perineural invasion (P = 0.42), temporal bone resection (P = 0.14), facial nerve sacrifice (P = 0.92), or type of parotid operation performed (P = 0.51).

Conclusions:

In this patient population, cervical, but not parotid, lymph node involvement was associated with poor outcomes. Furthermore, radiation therapy prior to a definitive operation resulted in worse outcomes and did not decrease the incidence lymph node metastases.