Carcinoma of the skin metastatic to the parotid area lymph nodes.

Abstract

We performed an analysis of treatment outcome at the University of Florida for 77 patients with previously untreated carcinoma of the skin metastatic to parotid area lymph nodes. Seventy-seven patients with 79 parotid node metastases were treated with curative intent between 1966 and 1994. All patients had a minimum 2-year follow-up. Treatment consisted of radiotherapy alone in 18 patients, preoperative radiotherapy in 6 patients (7 parotids), and postoperative radiotherapy in 53 patients (54 parotids). Overall rate of disease control in the parotid area at 5 years was 82%. Parotid area disease control according to treatment group revealed: surgery and postoperative radiotherapy, 43 of 48 (90%); preoperative radiotherapy and surgery, 4 of 5 (80%); and radiotherapy alone, 8 of 15 (53%). Multivariate analysis of parotid disease control revealed the following: treatment method (p = .0037), N stage (p = .0726), cranial nerve involvement (p = .1851), fixation (p = .1820), skin involvement (p = .1771), and sex (p = .5782). Overall 5-year absolute and cause-specific survival rates were 54% and 68%, respectively. The 5-year cause-specific survival rate was 72% after surgery and postoperative radiotherapy and 59% following radiotherapy alone. Multivariate analysis of cause-specific survival revealed the following: skin involvement (p = .0215), cranial nerve involvement (p = .1549), fixation (p = .0347), N stage (p = .4302), sex (p = .6806), and treatment method (p = .9599). Our current policy is to treat patients with tumor that is initially resectable with surgery followed by radiotherapy, whereas those who have initially unresectable disease undergo preoperative radiotherapy followed by surgical resection if the tumor becomes resectable. If surgery cannot be performed for medical reasons, patients still have better than a 50% chance of being cured with radiotherapy alone.