An immunosuppressed patient has a resectable parotid-tail metastasis from temple cutaneous squamous carcinoma. Imaging shows no clinically involved neck nodes. What is the best oncological principle?
Parotid nodal metastasis from high-risk cutaneous SCC carries substantial occult cervical risk; surgery is compartment-based, preserves an uninvolved nerve, and is commonly followed by risk-adapted adjuvant radiotherapy.
A. Enucleate the parotid node alone: Shelling out a node leaves other intraparotid nodes and ignores occult cervical disease.
B. Sacrifice the facial nerve routinely: The nerve should be preserved unless directly invaded or oncological clearance requires sacrifice.
C. Treat only the original skin scar: Regional metastatic disease requires parotid and neck management.
D. Parotidectomy with facial-nerve preservation if uninvolved, plus treatment of the at-risk ipsilateral neck: Parotid nodal metastasis from high-risk cutaneous SCC carries substantial occult cervical risk; surgery is compartment-based, preserves an uninvolved nerve, and is commonly followed by risk-adapted adjuvant radiotherapy.
E. Observe the N0 neck in every case: Clinical N0 status does not exclude substantial occult metastasis in this scenario.
If the facial nerve were preoperatively paralysed and encased on MRI, nerve sacrifice with reconstruction planning could be required for clearance.
Independent Clinora educational material; not official JCIE content, an accredited programme, clinical advice, or a substitute for local policy and specialist judgement.
Back to the Section 1 bank