Relevance of Intraparotid Metastases in Head and Neck Skin Squamous Cell Carcinoma

• Published in: The Laryngoscope Vol. 131; no. 4; p. 788
• Main Authors: Dür, Cilgia, Salmina, Cinzia, Borner, Urs, Giger, Roland, Nisa, Lluís
• Format: Journal Article
• Language: English
• Published: United States 01.04.2021
• Subjects: Aged; Aged, 80 and over; Female; Humans; Lymph Node Excision; Lymphatic Metastasis; Male; Middle Aged; Neck Dissection; Neoplasm Staging; Parotid Neoplasms - secondary; Parotid Neoplasms - surgery; Prognosis; Retrospective Studies; Skin Neoplasms - pathology; Skin Neoplasms - surgery; Squamous Cell Carcinoma of Head and Neck - secondary; Squamous Cell Carcinoma of Head and Neck - surgery; head and neck; neck metastasis; neck dissection; Cutaneous squamous cell carcinoma; parotid metastasis; parotidectomy
• ISSN: 1531-4995
• DOI: 10.1002/lary.28985

Parotid lymph node metastases are common in head and neck cutaneous squamous cell carcinoma (cSCCHN). Here we evaluate the diagnostic, prognostic, and therapeutic implications of intraglandular lymph node (IGLN) metastases in cSCCHN. Retrospective study in a tertiary referral university cancer institute. We included patients with cSCCHN who underwent parotidectomy and neck dissection (ND), with or without synchronous resection of the skin primary, between January 1999 and January 2018. The characteristics of cSCCHN with or without IGLN involvement were compared. Altogether, 68 patients were included. Of the 29 (42.6%) patients classified as cN0, eight were upstaged pN+ and had concomitant IGLN involvement. Of 21 patients with pN0 disease, IGLN metastases were absent in only three cases, resulting in a specificity and sensitivity of parotid metastases to diagnose occult nodal neck metastases of 14.29% and 100%, respectively. The positive and negative predictive values were 14.29% and 100%, respectively. Univariate analyses only displayed a significantly higher rate of moderately and poorly differentiated primaries in patients with IGLN metastases (P = .015). Only advanced T-stages were significantly associated with neck recurrences. IGLN status in advanced cSCCHN is potentially predictive for occul nodal neck metastases. Our results suggest that ND in patients with histopathologically negative IGLNs and clinically negative neck lymph nodes may not be necessary given the high negative predictive value of IGLN status in this group of patients. Therefore, accurate diagnostic evaluation of IGLN involvement is mandatory. 4 Laryngoscope, 131:788-793, 2021.