title: Outcomes following parotidectomy for metastatic squamous cell carcinoma with microscopic residual disease: implications for facial nerve preservation.
abstract: BACKGROUND
  Metastatic cutaneous squamous cell carcinoma (SCC) of the parotid is an aggressive disease, requiring combined modality treatment of surgery and adjuvant radiotherapy to achieve cure. This study aims to determine whether facial nerve preservation followed by radiotherapy is a reasonable option in patients with microscopic residual disease involving the facial nerve.
  
  
  METHODS
  One hundred seventy-six patients with metastatic cutaneous SCC involving the parotid were analyzed.
  
  
  RESULTS
  In this cohort, 15 patients who underwent nerve-sparing surgery and adjuvant radiotherapy were found to have involved margins adjacent to the facial nerve. Comparing this group to patients with clear margins showed no difference in local recurrence or survival. Only 3 patients in this group developed local recurrence, and all successfully salvaged by further surgery.
  
  
  CONCLUSIONS
  This study suggests that patients with metastatic cutaneous SCC to the parotid with microscopic residual disease involving the facial nerve and normal function can be successfully treated with a facial nerve-sparing approach and timely postoperative radiotherapy.
authors.affiliation: Sydney Head and Neck Cancer Institute, Sydney Cancer Centre, Royal Prince Alfred Hospital, Sydney, Australia. gopaliyer@yahoo.com
authors.forename: N Gopalakrishna
authors.initials: NG
authors.lastname: Iyer
authors.forename: Jonathan R
authors.initials: JR
authors.lastname: Clark
authors.forename: Rajmohan
authors.initials: R
authors.lastname: Murali
authors.forename: Kan
authors.initials: K
authors.lastname: Gao
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: O'Brien