Parotidectomy in patients with head and neck cutaneous melanoma with cervical lymph node involvement

Abstract

Background: Parotidectomy in melanoma of the coronal scalp and face with clinically involved cervical lymph node metastasis is based on predicted cervical lymphatic drainage described by O'Brien. Methods: In total, 40 parotidectomies with en bloc therapeutic neck dissection were retrospectively analyzed. Results: Lymphatic spread of melanoma to the parotid lymph nodes was observed in 10 of 40 specimens (25%). Eight of the 10 parotid-positive patients developed a recurrence vs 17 of the 30 parotid-negative patients (P = 0.28). There were no differences in overall survival, melanoma-specific survival, and disease-free survival between the parotid-positive and parotid-negative patients. Conclusion: Although in this series no survival differences were found, parotidectomy still merits a sustained role in therapeutic neck dissection procedures to improve regional control and to prevent facial nerve damage after surgery for a second relapse from occult metastases in the parotid. K E Y W O R D Shead and neck, melanoma, metastasis, parotid gland, parotidectomy

Head and neck melanoma: outcome and predictors in a population-based cohort study

“…By illuminating different aspects of END in treatment of HNM, most authors critically assessed this procedure and eventually do not recommend END as first-line therapy [ 18 ]. In contrast, for melanoma of the coronal scalp and face with signs of lymph node involvement, parotidectomy as an additional procedure is regarded as a valuable tool to improve loco-regional tumor control [ 25 ]. Hereby unsurprisingly, SLNB has evolved as state of the art procedure, however, not primarily to replace curative lymphadenectomy, but as an appropriate staging tool especially for intermediate-thickness tumors of 1–4 mm in HNM [ 3 , 5 ].…”

Predictors of Nodal Metastasis in Cutaneous Head and Neck Cancers

“…However, in a setting of clinically or microscopically positive intraparotid lymph nodes, a superficial parotidectomy and neck dissection are recommended by NCCN guidelines [ 39 ]. The incidence of occult parotid lymph node involvement in CHNM patients with cervical lymph node disease has been reported at 16.1–25% [ 58 , 59 ]. For this reason, if a patient has high-risk features for relapse and metastasis, parotidectomy should be considered at the time of primary surgery.…”

Superficial versus total parotidectomy for metastatic cutaneous squamous cell carcinoma and melanoma of the head and neck: a systematic review

“…Superficial parotidectomy was performed in cases where there was no pre-operative evidence of parotid nodal involvement (electively) 14 or as a therapeutic procedure with pre-operative evidence of parotid involvement. 16…”