To define the indications for elective neck treatment, the cases of 474 previously untreated patients were reviewed who had locally confined major salivary gland cancers treated between 1939 and 1982, Clinically positive nodes were present in 14% (67 of 474). Overall, clinically occult, pathologically positive nodes occurred in 12% (47 of 407). By univariate analysis, several factors appeared to predict the risk of occult metastases; however, multivariate analysis revealed that only size and grade were significant risk factors. Tumors 4 cm or more in size had a 20% (32 of 164) risk of occult metastases compared with a 4% (nine of 220) risk for smaller tumors [P < 0.00001). High‐grade tumors (regardless of histologic type) had a 49% (29 of 59) risk of occult metastases compared with a 7% (15 of 221) risk for intermediate‐grade or low‐grade tumors [P < 0.00001). In view of the low frequency of occult metastases in the entire group, routine elective treatment of the neck is not recommended. High‐grade tumors and larger tumors have a high rate of occult neck metastases, and treatment should be considered in this group.

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Three hundred and three patients with benign solitary neurilemomas, or schwannomas, not associated with the classical type of von Recklinghausen's disease were studied. One hundred and seventy‐two were women and 131 were men. Forty‐five percent of the tumors were seen in the extremities, and no specific area could be related to the development of these tumors. Approximately 9% of the tumors occurred in the soft tissues of the trunk and 14% in various unusual sites. Most patients were seen initially because of a painless mass; only 10 complained of pain radiating along the course of a peripheral nerve. One documented case of a malignant degeneration in a benign schwannoma has been reported. The treatment of a benign solitary neurilemoma is enucleation. Excision of a segment of a major peripheral nerve is contraindicated. The histologic features of benign peripheral nerve tumors were briefly described. The confusion regarding terminology has been discussed, and it is suggested that the term schwannoma be more frequently used. The lack of neurologic deficit in schwannomas arising in major peripheral nerves has been pointed out, and further studies have been suggested. The high association of malignant tumors in these patients has been discussed, and it is proposed that a further study be undertaken to ascertain whether these patients are more prone to develop unrelated cancers.

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