Cutaneous squamous cell carcinoma metastasis to the parotid region lymph nodes

Objective: To determine the effect on survival of periauricular region cutaneous squamous cell carcinomas (cSCC) metastasizing to parotid region and cervical lymph nodes. Methods: From May 1995 to October 2013, consecutive patients with cSCC undergoing parotidectomy/neck dissection ≥ 18 years without distant metastasis were included. Demographic, clinical, and pathologic data were analyzed. Uni- and multivariate analyses of disease-specific survival and overall survival were performed. Statistical significance was set at P < 0.05. Results: We evaluated 137 patients. Most patients were Caucasian males with an average age of 71.6 years. The median follow-up time was 29.4 months. Thirty-six percent of patients had pathological evidence of cervical metastasis (N+). Seven percent had metastasis to level I, 21.9% to level II, 14.6% to level III, 8% to level IV, and 9.5% to level V. Thirty-nine percent of patients had metastasis to parotid region (P+). The average number of positive:total nodes from parotidectomy was 1.9:4.6. The median overall and disease-specific survival times were 2.81 and 1.96 years, respectively. Patients with either neck or parotid metastasis (N + or P+) had significantly decreased survival, hazard ratio 2.298 (1.2739, 4.1445), compared to patients without metastasis (N0P0), P < 0.0057. Conclusion: Patients with periauricular region cSCC metastasizing to parotid and cervical regions lymph nodes have significantly decreased survival compared with patients without cervical and/or parotid metastasis. Metastasis to parotid region should be considered as a distinct head and neck level when staging periauricular cancers. This study provides a basis for further studies to validate these findings. Level of Evidence: 4. Laryngoscope, 129:1579–1586, 2019.