Abstract
Objective
Cutaneous Squamous Cell Carcinoma (cSCC), a tumor with a significantly increasing incidence, is mostly diagnosed in the head region, where tumors have a worse prognosis and a higher risk of metastases. The presence of metastases reduces specific five-year survival from 99% to 50%. As the risk of occult metastases does not exceed 10%, elective dissection of the tributary parotid and neck lymph nodes is not recommended.
Methods
We retrospectively analyzed a group of 12 patients with cSCC of the head after elective dissections of regional (parotid and cervical) nodes by means of superficial parotidectomy and selective neck dissection.
Results
We diagnosed occult metastases neither in the cervical nor parotid nodes in any patient. None were diagnosed as a regional recurrence during the follow-up period.
Conclucion
Our negative opinion on elective parotidectomy and neck dissection in cSCC of the head is in agreement with the majority of published studies. These elective procedures are not indicated even for tumors showing the presence of known (clinical and histological) risk factors for lymphogenic spread, as their positive predictive value is too low. Elective parotidectomy is individually considered as safe deep surgical margin. If elective parotidectomy is planned it should include only the superficial lobe. Completion parotidectomy and elective neck dissection are done in rare cases of histologically confirmed parotid metastasis in the parotid specimen. Preoperatively diagnosed parotid metastases without neck involvement are sent for total parotidectomy and elective selective neck dissection. Cases of clinically evident neck metastasis with no parotid involvement, are referred for comprehensive neck dissection and elective superficial parotidectomy. The treatment of concurrent parotid and cervical metastases includes total conservative parotidectomy and comprehensive neck dissection.
Level of evidence
How common is the problem?
Step 4 (Case-series)
Is this diagnostic or monitoring test accurate? (Diagnosis)
Step 4 (poor or non-independent reference standard)
What will happen if we do not add a therapy? (Prognosis)
Step 4 (Case-series)
Does this intervention help? (Treatment Benefits)
Step 4 (Case-series)
What are the COMMON harms? (Treatment Harms)
Step 4 (Case-series)
What are the RARE harms? (Treatment Harms)
Step 4 (Case-series)
Is this (early detection) test worthwhile? (Screening)
Step 4 (Case-series)
Keywords
Skin cancer; Cutaneous squamous cell carcinoma; Elective parotidectomy; Elective neck dissection; Occult metastasis
Highlights
Metastases in cutaneous spinalioma significantly reduce the prognosis.
Tumor parameters increasing the risk of their incidence are known.
Elective parotidectomies were performed for high-risk skin head tumors.
Occult metastases were not found in any of the patients.
Elective parotidectomy is not beneficial even for high-risk tumors.
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