Background Aggressive nonmelanoma skin cancer (ANMSC) of the head and neck may
require parotidectomy because of neurotropic spread, direct invasion of the
parotid gland, or parotid metastasis.
Objective To review our experience with parotidectomy in the treatment of these
tumors to examine the indications for this procedure and to analyze treatment
outcomes. We emphasize the importance of early identification of an ANMSC
and a systematic approach to treatment.
Design Review of 23 patients with an ANMSC who required parotidectomy with
or without facial (VII) nerve sacrifice between January 5, 1996, and December
27, 1999. Median follow-up for all patients was 24 months.
Setting Academic tertiary care referral center.
Patients This study focused on 23 (median age, 71 years) of 54 patients treated
for an ANMSC. Most tumors were in the periauricular (n = 9) and the frontozygomatic
(n = 6) areas. Seven patients presented with facial weakness or paralysis.
Three patients had clinically evident parotid metastasis, while 14 patients
had tumors directly invading the parotid gland. Eighteen patients had recurrent
disease that had been treated previously with Mohs micrographic surgery.
Interventions Following wide local excision of the ANMSC, 12 patients had resection
of the lateral parotid lobe with preservation of the nerve, while 11 required
radical parotidectomy with sacrifice of 1 or more branches. Nineteen patients
received cervical lymphadenectomy. Postoperative radiotherapy was administered
in 19 patients.
Main Outcome Measures Tumor pathologic findings (specifically, perineural invasion of the
facial nerve), locoregional control or recurrence, disease-free survival,
disease-specific survival, and overall survival.
Results Neurotropic spread to the facial nerve was present in 6 patients and
was more likely to occur in younger patients (51 vs 75 years, P = .006). Locoregional failures occurred in 9 patients following treatment.
Patients who required parotidectomy in their surgical treatment for an ANMSC
were more likely to have recurrent disease (P = .0002).
Disease-specific and overall survival was 79% and 69%, respectively, at 42
months.
Conclusions Patients with ANMSC may require parotidectomy in the context of neurotropic
spread, regional metastasis, or direct invasion into the parotid gland. Surgery
combined with postoperative radiotherapy is necessary in most patients because
of adverse clinical and pathologic findings. A systematic approach to the
management of the parotid and facial nerve in the presence of these aggressive
tumors is required. Despite comprehensive treatment, local recurrence of ANMSC
and mortality remain high.
