Including Parotidectomy in Neck Dissection for Head and Neck Cutaneous Melanoma
Posted: Tuesday, April 2, 2019
Including a parotidectomy in a neck dissection to treat cutaneous melanoma may not offer a survival benefit, but it “still merits a sustained role…to improve regional control and to prevent facial nerve damage after surgery for a second relapse from occult metastases in the parotid,” according to a retrospective analysis, published in Head & Neck. However, according to Danique Berger, MD, of the Netherlands Cancer Institute, and colleagues, “the future role of immunotherapy may have [a] serious impact on the discussion of parotidectomy.”
The researchers retrospectively analyzed 40 patients with histologically or cytologically proven N-positive head and neck cutaneous melanoma. All patients had undergone neck dissections with parotidectomies at the Netherlands Cancer Institute.
In 10 of the 40 cases (25%), the parotidectomy detected that cancer had spread to the parotid lymph nodes (parotid-positive), and 30 cases were parotid-negative. In the authors’ opinion, this is a “relatively high percentage” of metastases and justifies including a parotidectomy. However, the authors found no differences in overall survival, melanoma‐specific survival, or disease‐free survival between patients with parotid-positive and parotid-negative disease. There was no statistically significant difference between recurrence in patients with parotid-positive disease (80%) compared with patients with parotid-negative disease (57%).
A later parotidectomy carries a higher risk of facial nerve damage, partly because of the risk of fibrosis from post–neck dissection radiotherapy. The study was retrospective and conducted at a single site, the authors acknowledged, and is also limited by its relatively small sample size.
Disclosure: The study authors reported no conflicts of interest.