PAROTID NODE

POSITIVE AT PRESENTATION

  • treatment similar to high-grade parotid neoplasm

Primary Treatment

  • Surgery is the initial procedure
    • lateral lobectomy
      • If palpable nodes then superficial parotidectomy
    • total parotidectomy or
    • radical parotidectomy
  • upper neck nodes are treated (see below)

Neck nodes are clinically negative

  • elective neck dissection - OR -
  • post-operative radiation is planned
  • Routine irradiation of the clinically N0 neck from cutaneous SCCA is recommended.[2]
    • 50% (7/14) neck recurrence w/o ENI.
    • 0% (0/15) neck recurrence with ENI.

Upper neck node is clinically positive

  • neck dissection is added - AND -
  • post-operative radiation therapy is recommended in nearly all cases.
  • Node+ then post-op RT to 60-65Gy or radical parotidectomy.
  • prefer to combine surgery + RT with LC rate of >85% while allowing for facial nerve preservation.

PAROTID NODE METASTASIS AFTER PRIMARY SKIN TREATMENT

Surgery

  • then a lateral lobectomy in the plane of the nerve upper neck dissection is the treatment of choice
    • if LN are small and mobile
  • An individualized major resection of the parotid and involved tissues is required,
    • If LN are large and tumor is
    • growing through the capsule of the LN with fixation to skin,
    • extension to the tragus or pinna,
    • or gross invasion of the facial nerve, masseter muscle, mandible, or deep lobe of the parotid gland,

Radiation Timing

  • Preoperative RT should be considered in the advanced cases.
  • Adjuvant radiotherapy is generally given to the parotid and first echelon LN.

Radiation Dose Depending on Surgical Margin

  • Negative: 60 Gy to the parotid and 50 Gy to undissected neck
  • Close or positive: 65-70 Gy to the parotid and 50 Gy to undissected neck

Results

  • Median survival after relapse was 9 months.
  • All patients experiencing relapse died with most (11 of 13) dying from metastatic disease.[1]
Bibliography
1. Howle JR, Morgan GJ, Kalnins I, Palme CE, Veness MJ. Metastatic cutaneous squamous cell carcinoma of the scalp. ANZ J Surg. 2008 Jun;78(6):449-53.
2. Chen AM, Grekin RC, Garcia J, Bucci MK, Margolis LW.Radiation therapy for cutaneous squamous cell carcinoma involving the parotid area lymph nodes: dose and volume considerations.Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1377-80.
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