Oncologic outcomes and surgical morbidity of prophylactic parotidectomy in clinically node-negative cutaneous squamous cell carcinoma of the face and scalp.

BACKGROUND: The role of prophylactic parotidectomy (PP) in managing clinically node-negative (cN0) cutaneous squamous cell carcinoma (cSCC) of the face and scalp remains controversial. AIMS/OBJECTIVES: To evaluate the oncologic outcomes and complication rates of PP compared to an observation-only approach. MATERIAL AND METHODS: A retrospective analysis was conducted on 46 patients with cN0 cSCC of the face and anterior/temporoparietal scalp treated between 2000 and 2020. Patients were divided into the PP (n = 26) and control (n = 20) groups. Primary endpoints included occult metastasis rates, recurrence-free survival (RFS), disease-specific survival (DSS), and complications. RESULTS: Occult metastasis to the parotid gland was observed in 3.8% (1/26) of the PP group, whereas occult neck metastasis was identified in 19.2% (5/26). The overall complication rate was significantly higher in the PP group (65.4% vs. 5.0%, p < 0.001), with facial nerve paralysis occurring in 42.3%. No significant differences were found in 5-year RFS (p = 0.971) or DSS (p = 0.911) between the groups. CONCLUSIONS AND SIGNIFICANCE: PP did not demonstrate a statistically significant survival benefit in our cN0 cSCC cohort but was associated with substantial surgical morbidity. Careful, individualized decision-making and a 'parotid-sparing' strategy with rigorous nodal surveillance serve as a viable alternative.