Total versus superficial parotidectomy for stage III melanoma

Abstract

Parotid bed melanoma recurrence was more common after superficial parotidectomy compared to total parotidectomy, and recurrence resulted in significant facial nerve functional deficit. Our results support total parotidectomy when metastatic melanoma involves the parotid nodal basin.

Deep lobe parotidectomy—why, when, and how?

“…Removal of the deep lobe seems to reduce local recurrence risk compared to no deep lobe removal and radiation therapy [22,24]. Local recurrence is a serious finding with skull base pain, masses, 7th nerve paralysis, and risk of additional spread, etc.…”

“…The study by Thom et al showed that with an extraparotid primary with metastasis to a superficial intraparotid lymph node, metastasis to the cervical lymph nodes occurred in 29%, and metastasis to the deep parotid nodes occurred in 22% of cases, almost similar findings of metastatic disease [22]. A study by Wertz et al found that for stage 3 melanoma with metastasis to the parotid gland, patients who underwent total parotidectomy had less parotid bed recurrence than did those people who had only a superficial parotidectomy [24]. This study confirmed the oncological benefit of deep lobe removal.…”

AHNS series: Do you know your guidelines? Diagnosis and management of salivary gland tumors

“…65,68,69,71 The primary rationale for performing total parotidectomy in high-risk parotid cancers and metastatic cutaneous cancers is that nodal involvement of the deep lobe is a common finding. 68,71,72 However, given the increased risk of total parotidectomy over superficial parotidectomy, such a procedure is ideally performed by surgeons with sufficient experience in head and neck surgery.…”

Cranial nerve outcomes in regionally recurrent head & neck melanoma after sentinel lymph node biopsy

“…Delayed excision of macroscopically positive NSLN's may alternatively negate benefits of iCLND risk‐avoidance by heightening complications and lengthening hospitalizations . Specifically, intraparotid disease control is paramount in stage III HNCM, as nodal recurrence in an undissected deep parotid lobe is associated with a 42% CN VII injury risk . Challenges for surgeons and patients arising from salvage interventions and palliation of uncontrolled regional disease in HN malignancies provide further support for iCLND.…”

“…Here, we test the hypothesis that regional HNCM recurrence and/or ensuing salvage dissection will lead to poorer CN outcomes. Finally, we evaluate the effects of parotidectomy timing and extent on recurrence‐related CN injuries by comparing immediate superficial parotidectomy, intraparotid recurrences following FN SLNB, and published total parotidectomy rates …”