Low total lymph node ratio is associated with improved outcomes in node-positive head and neck cutaneous SCC. © 2017 Wiley Periodicals, Inc. Head Neck 39: 772-778, 2017.

Objectives Extent of parotidectomy and neck dissection for metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is debated. We describe our experience, analyzing outcomes (overall survival and regional recurrence) associated with surgical extent and adjuvant treatment. Study Design A retrospective cohort study of parotidectomy with or without neck dissection for metastatic cSCC. Setting A tertiary referral cancer center in Australia. Subjects and Methods The study group consisted of patients with metastatic cSCC involving the parotid gland who underwent a curative-intent parotidectomy (superficial or total), with or without neck dissection, between 2003 and 2014. Demographic and clinical data, treatment modalities, and outcome parameters were collected from the electronic institutional database. Results Of 78 patients, 65 underwent superficial parotidectomy. Median follow-up was 6.5 years. Sixty-four patients (82%) patients received adjuvant radiotherapy. Cervical lymph nodes were involved in 6 (24%) elective neck dissections. Involved preauricular, facial, external jugular, and occipital nodes occurred in 36.9%. Adjuvant radiotherapy was associated with improved 5-year survival-50% (95% CI, 36%-69%) versus 20% (95% CI, 6%-70%)-and improved 2-year regional control: 89% (95% CI, 67%-100%) versus 40% (95% CI, 14%-100%). The ipsilateral parotid bed recurrence rate was 3.7% for those who received adjuvant radiotherapy and 27% for those who did not receive radiotherapy. Conclusion This study supports surgery plus adjuvant radiotherapy as a standard of care for metastatic cSCC. The low incidence of parotid bed recurrence with this approach suggests that routine elective deep lobe resection may not be required.

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Background: Surgeon-performed ultrasound (SUS) changes management and surgical decision-making. It allows for immediate ultrasound-guided fine-needle aspiration (US-FNA) for the work-up of neck masses, lymph node metastases and thyroid nodules. We examined the introduction of SUS to an Australian Head and Neck cancer unit, identifying situations where it was used, and evaluated the diagnostic adequacy and accuracy of US-FNA. Methods: A prospective database was created for all patients undergoing SUS and US-FNA, performed by two head and neck surgeons, between September 2018 and June 2019. The data were retrospectively analysed to identify when SUS was performed. Diagnostic adequacy and accuracy of US-FNA were determined after evaluating formal cytology and histopathology reports. Results: A total of 183 diagnostic, surveillance and interventional SUS scans were performed for multiple indications. A total of 100 US-FNAs were performed on a number of different sites. Diagnostic adequacy and accuracy were 92% and 85%, respectively. Conclusion: After the introduction of SUS to our weekly routine head and neck cancer clinic, we identified multiple situations where it can be used successfully within our clinical landscape. Our diagnostic US-FNA results compared favourably to current literature, without additional need for clinic attendance by consultant radiologists or pathologists, saving valuable hospital resources. This introduction proposes a promising alternative to current neck lump clinic models.© 2020 Royal Australasian College of Surgeons ANZ J Surg 90 (2020) 861-866ANZJSurg.com