Surgical Management of Patients with Parotid Involvement from Non-Melanoma Skin Cancer of the Head and Neck

TL;DR

This study examines surgical outcomes for head and neck non-melanoma skin cancer patients with parotid involvement, identifying factors linked to worse survival and recurrence.

Contribution

The study identifies positive surgical margins as a critical prognostic factor and emphasizes the need for extensive resection and reconstruction in advanced cases.

Findings

Positive surgical margins significantly correlate with worse disease-specific survival.

Facial nerve involvement, lymph vascular invasion, and histological grading are associated with poorer outcomes.

Extensive surgical resection with reconstruction is recommended for advanced disease.

Abstract

We conducted a retrospective, longitudinal study on a single-center series of patients who underwent parotidectomy in the management of advanced head and neck non-melanoma skin cancer (hnNMSC). The aim of this study was to identify prognostic factors associated with worse outcomes. Forty-one men and nine women were included. The mean age at the time of surgery was 78.9 years. The 5-year overall survival, disease-specific survival, locoregional recurrence-free survival, and distant metastasis-free survival calculated with Kaplan–Meier curves were 39.9%, 56.3%, 58.6%, and 82.1%, respectively. A univariate analysis showed that the status of the margins, facial nerve direct involvement, lymph vascular invasion, and histological grading were associated with worse outcomes (p < 0.05). Positive margins were associated with worse disease-specific survival also in a multivariate analysis (p = 0.001, HR = 32.02, and CIs 4.338 to 351.3). Because the resection in free margins is the most important prognostic factor, early diagnosis or, in the case of advanced disease, extensive surgical resection with concomitant reconstruction is needed. Adjuvant therapy is indicated in selected cases.