Aims: To review oncological outcomes in patients with high risk head and neck cutaneous SCC (HNcSCC) - as defined by the presence of metastatic involvement of the parotid lymph nodes. To correlate clinical data with pathological review in order to identify predictors of disease behaviour, and potential therapeutic targets.

Methods: A search of our institutional database was undertaken to identify patients with regional parotid nodal involvement from likely HNcSCC, treated with radical intent between January 2000 and June 2014. Patients were excluded if (1) the parotid mass represented local recurrence / direct invasion from tumour, or (2) there was a previous history of, or subsequent development at <2 years of a head and neck mucosal SCC.

Results: 151 patients were identified as suitable for inclusion. Median follow-up was 4 years. 89 % were male. Median age was 75 years. 21% were immunosuppressed. Parotidectomy was superficial in 68% and total/subtotal in 32% and 64% also underwent neck dissection. All patients underwent post-operative radiotherapy to a median dose of 60 Gy (range 45-70). At 2 and 5 years: LRC was 81% and 73%, DFS was 58% and 41%, and OS was 69 and 48% respectively. The 5 year distant metastatic free rate was 81%.

Conclusions: Regionally metastatic high-risk HNcSCC is an aggressive disease. Despite radical treatment, there is a moderate rate of locoregional recurrence, and 5yr survival rates are <50% due to both disease recurrence and other causes in this population. Further study of molecular changes in this cohort of high-risk HNcSCC, including p16 / HPV/ EGFR over-expression studies, may predict disease behaviour and identify targets for more effective therapies.
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