# Novel technique in intraoperative localisation of skin cancer metastasis using ultrasound guidance: a case report

## TL;DR

This case report describes using intraoperative ultrasound to guide the removal of a difficult-to-localize skin cancer metastasis in the parotid gland.

## Contribution

The paper introduces the novel use of low-frequency ultrasound during surgery to enhance tumour detection and resection in complex anatomical areas.

## Key findings

- Intraoperative ultrasound successfully identified the tumour boundaries and facial nerve location.
- The technique enabled complete resection without residual disease or unnecessary radical surgery.
- Ultrasound guidance proved more effective than preoperative imaging for lesion localisation.

## Abstract

Localisation of metastatic squamous cell carcinoma (SCC) often poses intraoperative challenges. There is limited description of surgical practices to address these difficulties in the literature. Low-frequency ultrasound use intraoperatively may enhance tumour detection and facilitate complete resection.

We present the case of a 78-year-old male with right-sided intra-parotid metastatic SCC requiring surgical excision. This was completed under intraoperative ultrasound scan guidance. Preoperative whole-body PET-CT and MRI of the head were inadequate for confirming accurate lesion localisation regarding the depth of invasion and facial nerve involvement. Intraoperative ultrasound performed by a consultant radiologist guided the metastasectomy by confirming lesion boundaries, navigating safe excision by sparing the facial nerve branches and facilitating the avoidance of more radical resection. Full resection with no residual disease was confirmed intraoperatively with the ultrasound.

We propose using ultrasound guidance intraoperatively to aid localisation and excision of metastatic disease in anatomically challenging sites.