CARCINOMA OF THE SKIN METASTATIC TO THE PAROTID AREA LYMPH-NODES

Background. We performed an analysis of treatment outcome at the Unive rsity of Florida for 77 patients with previously untreated carcinoma o f the skin metastatic to parotid area lymph nodes. Methods. Seventy-se ven patients with 79 parotid node metastases were treated with curativ e intent between 1966 and 1994. All patients had a minimum 2-year foll ow-up. Treatment consisted of radiotherapy alone in 18 patients, preop erative radiotherapy in 6 patients (7 parotids), and postoperative rad iotherapy in 53 patients (54 parotids). Results. Overall rate of disea se control in the parotid area at 5 years was 82%. Parotid area diseas e control according to treatment group revealed: surgery and postopera tive radiotherapy, 43 of 48 (90%); preoperative radiotherapy and surge ry, 4 of 5 (80%); and radiotherapy alone, 8 of 15 (53%). Multivariate analysis of parotid disease control revealed the following: treatment method (p =.0037), N stage (p =.0726), cranial nerve involvement (p =. 1851), fixation (p=.1820), skin involvement (p =.1771), and sex (p =.5 782). Overall 5-year absolute and cause-specific survival rates were 5 4% and 68%, respectively. The 5-year cause specific survival rate was 72% after surgery and postoperative radiotherapy and 59% following rad iotherapy alone. Multivariate analysis of cause-specific survival reve aled the following. skin involvement (p =.0215), cranial nerve involve ment (p =.1549), fixation (p =.0347), N stage (p =.4302), sex (p =.680 6), and treatment method (p =.9599). Conclusions. Our current policy i s to treat patients with tumor that is initially resectable with surge ry followed by radiotherapy, whereas those who have initially unresect able disease undergo preoperative radiotherapy followed by surgical re section ii the tumor becomes resectable. if surgery cannot be performe d for medical reasons, patients still have better than a 50% chance of being cured with radiotherapy alone. (C) 1998 John Wiley & Sons, Inc.