loading page

Parotidectomy and neck dissection in locally advanced and relapsed cutaneous squamous cell carcinoma of Head and Neck Region
  • +5
  • Giulianno Melo,
  • Luiz Guilherme,
  • Arthur Gatti,
  • Juliana Pacheco,
  • Marcel Palumbo,
  • Fabiano Callegari,
  • Marcio Abrahao,
  • Onivaldo Cervantes
Giulianno Melo
Federal University of Sao Paulo Paulista Medical School

Corresponding Author:[email protected]

Author Profile
Luiz Guilherme
Federal University of Sao Paulo Paulista Medical School
Author Profile
Arthur Gatti
UNIFESP - Universidade Federal de São Paulo, Federal University of Sao Paulo Paulista Medical School
Author Profile
Juliana Pacheco
Federal University of Sao Paulo Paulista Medical School
Author Profile
Marcel Palumbo
Federal University of Sao Paulo Paulista Medical School
Author Profile
Fabiano Callegari
Federal University of Sao Paulo Paulista Medical School
Author Profile
Marcio Abrahao
Federal University of Sao Paulo Paulista Medical School
Author Profile
Onivaldo Cervantes
Federal University of Sao Paulo Paulista Medical School
Author Profile

Abstract

Objective: To investigate the prognostic factors to developing parotid and neck metastasis in locally advanced and relapsed cutaneous squamous cell carcinoma (CSCC) of the head and neck region. Study Design: Retrospective cohort study. Setting: Single-center study enrolling consecutive patients with advanced CSCC from 2009 to 2019. Subjects and Methods: Seventy-four cases were identified. Study variables demographic data, clinical skin tumor stage, neck stage, parotid stage (P stage), surgical treatment features, and parotid, regional, and distant metastases. Survival measures: overall survival (OS) and disease-specific survival (DSS). Results: The study group included 72.9% men (median age, 67 years); 67.5% showed T2/T3 tumors, 90.5% comorbidities, 20.2% immunosuppressed, with median follow-up: 35.8 months. The most frequent skin primary were auricular and eyelid regions, 75% underwent primary resection with flap reconstruction. Parotid metastasis was present in 50%, 32.4% showing parotid extracapsular spread, multivariate analysis found OR=37.6 of positive parotid metastasis evolve into positive neck metastasis, p=0.001. Occult neck metastasis, neck metastasis, and neck extracapsular spread were observed in 13.5%, 51.3%, and 37.8%, respectively. Kaplan-Meier survival: Clinical T4 and T1, p=0.028, P1 stage: 30% and 5% survival at 5 and 10 years, P3 stage: 0%, p=0.016; OS and DSS showed negative survival for the parotid metastasis group, p=0.0283. Conclusion: Our outcomes support a surgically aggressive approach for locally advanced and relapsed CSCC, with partial parotidectomy for P0, total parotidectomy for P1-3, selective I-III neck dissection for all patients and adjuvant radiochemotherapy to appropriately treat patients with advanced CSCC of the head and neck region.
Dec 2021Published in Brazilian Journal of Otorhinolaryngology. 10.1016/j.bjorl.2021.11.007