Challenges in the management of metastatic cutaneous squamous cell carcinomas of the head and neck

Czech version

Authors: Z. Horáková; Ivo Stárek; R. Salzman
Authors‘ workplace: Klinika otorinolaryngologie a chirurgie hlavy a krku LF UP a FN Olomouc
Published in: Otorinolaryngol Foniatr, 75, 2026, No. 2, pp. 102-111.
Category: Review Article
doi: https://doi.org/10.48095/ccorl2026102

Overview

The incidence of cutaneous squamous cell carcinomas (cSCC), including their metastatic forms, is steadily increasing. For most cSCCs of the head, the primary regional lymphatic drainage area is the parotid lymph nodes. Metastases often present as isolated recurrences occurring after resection of the primary tumor. The risk of metastasing is difficult to stratify with precision using currently known clinical and pathological parameters. The development of metastases significantly worsens the otherwise excellent prognosis of localized cSCC, reducing the 5-year survival rate to just 50–65%. Therefore, adequate resection of the primary skin tumor is of critical importance. Elective lymphadenectomy is not indicated in cSCC. Due to their rapid and aggressive growth, parotid metastases require radical multimodal treatment. This includes complete surgical resection –⁠ via partial superficial, total, or extended parotidectomy –⁠ combined with elective or therapeutic neck dissection (ND), followed by adjuvant radiotherapy (RT), and in some cases, chemoradiotherapy. After completion of treatment, regular follow-up is essential, particularly for high-risk forms of cSCC. This surveillance should include monitoring of the regional lymphatic system.

Keywords:

parotidectomy – cutaneous squamous cell carcinoma – parotid gland carcinoma – parotid metastases

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