Cutaneous squamous cell carcinomas (cSCC) are malignant tumours with excellent prognosis unless nodal metastases develop. The aim of our study is to determine the prognostic significance of the clinical stage of parotid gland metastases and the incidence of occult cervical lymph node involvement in cSCC of the head. Our retrospective analysis includes 39 patients with cSCC parotid gland metastases, 15 of whom had concurrent cervical node involvement. In 32 patients, the lymph nodes manifested at stage N3b. A total of 26 patients were treated with parotidectomy, 9 patients received radiotherapy alone, and 4 received symptomatic therapy. The surgical treatment included either total conservative (21 cases) or superficial parotidectomy (5 cases) and neck dissection (therapeutic neck dissections in 11 cases and elective in 14 cases). In all cases, surgery was performed with sufficient tumour-free resection margins. Adjuvant radiotherapy was administered postoperatively in 16 patients. Occult metastases were present in 21% of cases after an elective neck dissection, but not in any case in the deep lobe of the parotid gland. The five-year overall survival and recurrence-free interval were 52% and 55%, respectively. Patients with the cN3b stage and G3 histological grade tend to have a worse prognosis, but not at a statistically significant level. The prognosis was not worse in patients with concurrent parotid and cervical metastases compared to those with metastases limited to the parotid gland only. The addition of adjuvant irradiation, in comparison to a single modality surgical treatment, was the only statistically significant prognostic factor that reduced the risk of death from this diagnosis (). The extent of parotidectomy (partial vs. total) had no impact on either the risk of recurrence or patient prognosis. The combination of surgery with irradiation provides the best results and should be applied to all patients who tolerate the treatment. A partial superficial parotidectomy should be sufficient, with a minimum risk of occult metastasis in the deep lobe. Conversely, the relatively high incidence of occult neck metastases indicates that patients could likely benefit from elective neck dissection.

中文翻译：

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头部皮肤鳞状细胞癌的腮腺转移：隐匿性转移的发生及其晚期表现

皮肤鳞状细胞癌（cSCC）是一种预后良好的恶性肿瘤，除非出现淋巴结转移。我们研究的目的是确定腮腺转移临床分期的预后意义以及头部鳞状细胞癌中隐匿性颈部淋巴结受累的发生率。我们的回顾性分析包括 39 例 cSCC 腮腺转移患者，其中 15 例并发颈淋巴结受累。32 名患者的淋巴结出现在 N3b 期。共有26例患者接受腮腺切除术，9例患者接受单纯放疗，4例患者接受对症治疗。手术治疗包括完全保守（21例）或腮腺浅切除术（5例）和颈清扫术（治疗性颈清扫术11例，择期14例）。在所有病例中，手术都是在有足够的无肿瘤切除边缘的情况下进行的。16例患者术后接受辅助放疗。选择性颈清扫术后，21% 的病例出现隐匿性转移，但腮腺深叶均未出现隐匿性转移。五年总生存率和无复发间隔分别为 52% 和 55%。cN3b 分期和组织学分级为 G3 的患者预后往往较差，但未达到统计学显着水平。与仅转移至腮腺的患者相比，同时发生腮腺和颈部转移的患者的预后并不差。与单一手术治疗相比，辅助放疗是降低该诊断死亡风险的唯一具有统计学意义的预后因素。）。腮腺切除术的范围（部分与全部）对复发风险或患者预后没有影响。手术与放疗相结合可提供最佳效果，应适用于所有耐受治疗的患者。部分浅表腮腺切除术应该足够了，深叶隐匿性转移的风险最小。相反，隐匿性颈部转移的发生率相对较高表明患者可能受益于选择性颈清扫术。