Parotid metastatic disease from cutaneous squamous cell carcinoma: Prognostic role of facial nerve sacrifice, lateral temporal bone resection, immune status and P- stage

BackgroundRecognized prognostic indicators for metastatic cutaneous squamous cell carcinoma (SCC) of the head and neck include facial nerve involvement, immune status, and parotid staging system (P-stage). We sought to examine the impact of lateral temporal bone resection (LTBR) on prognosis. MethodsWe conducted a retrospective analysis of 160 patients with metastatic cutaneous SCC to the parotid. All patients had parotidectomy and neck dissection; 27% had additional LTBR when the tumor was adherent to the temporal bone. ResultsOverall 5-year survival was 48%, disease-specific survival 77%, and locoregional control 83%. Corresponding results for immunocompetent versus immunocompromised were 55%, 86%, and 87% versus 12%, 48%, and 64%. On Cox regression analysis, only immunocompromised status (ie, lymphoproliferative disorder, organ-transplant patient) was prognostically significant (p < .001). ConclusionMore radical resection that may include LTBR mitigates the poorer prognosis with advanced disease in our series. Treatment must be individualized in immunocompromised patients who have shortened overall survival. (c) 2013 Wiley Periodicals, Inc. Head Neck36: 545-550, 2014