{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T02:43:59Z","timestamp":1782960239255,"version":"3.54.5"},"reference-count":20,"publisher":"Wiley","license":[{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"},{"start":{"date-parts":[[2026,7,1]],"date-time":"2026-07-01T00:00:00Z","timestamp":1782864000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Head &amp; Neck"],"abstract":"ABSTRACT<\/jats:title>\n \n Background<\/jats:title>\n Metastatic cutaneous squamous cell carcinoma (cSCC) to the parotid is increasing in incidence, and surgery remains the primary treatment modality. A previous publication investigating the outcomes of microscopically involved margins (R1) on the facial nerve found that survival is not compromised when a nerve\u2010sparing approach with adjuvant radiotherapy is employed. However, it is unknown whether this approach is reasonable in all situations where achieving a clear surgical margin requires the sacrifice of important anatomic structures. The aim of this study is to analyze an expanded cohort of patients with metastatic cSCC to the parotid to test the hypothesis that an involved surgical margin during parotidectomy is associated with worse outcomes.<\/jats:p>\n <\/jats:sec>\n \n Methods<\/jats:title>\n Patients who were treated surgically with curative intent for metastatic cSCC to the parotid with a known margin status were identified from a prospectively maintained database. Demographic, staging, and treatment details were recorded as well as recurrence and survival data. The cohort was analyzed for associations with regional control in the parotid and neck (RC), distant control, and disease\u2010specific survival (DSS). Overall survival (OS) was not analyzed due to competing risks.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n This study analyzed 291 patients, with a mean age of 74\u2009years. Most patients received adjuvant radiotherapy (63%). The estimated 5\u2010year OS was 45%, DSS was 77%, with a RC rate of 92%. An involved parotid nodal margin was associated with worse RC (\n p<\/jats:italic>\n \u2009=\u20090.04), distant control (\n p<\/jats:italic>\n \u2009=\u20090.04) and DSS (\n p<\/jats:italic>\n \u2009=\u20090.01). After adjusting for confounders, an involved margin was associated with 114% higher risk of disease\u2010specific death (HR 2.14, 95% CI 1.12\u20134.11,\n p<\/jats:italic>\n \u2009=\u20090.022) but there was no statistical difference in RC (\n p<\/jats:italic>\n \u2009=\u20090.068).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusion<\/jats:title>\n An involved microscopic parotid nodal margin is associated with significantly worse DSS.<\/jats:p>\n <\/jats:sec>","DOI":"10.1002\/hed.70354","type":"journal-article","created":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:50:21Z","timestamp":1782957021000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["The Impact of Margin Status Following Surgery for Metastatic Cutaneous Squamous Cell Carcinoma to the Parotid Gland"],"prefix":"10.1002","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8446-3288","authenticated-orcid":false,"given":"Rajith L.","family":"Mendis","sequence":"first","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Department of Head and Neck Surgery Westmead Hospital Westmead New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Timothy","family":"Manzie","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1209-772X","authenticated-orcid":false,"given":"Jonathan R.","family":"Clark","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"},{"name":"The Royal Prince Alfred Institute of Academic Surgery Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruta","family":"Gupta","sequence":"additional","affiliation":[{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"},{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Veronica","family":"Cheung","sequence":"additional","affiliation":[{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"},{"name":"Department of Tissue Pathology and Diagnostic Oncology Royal Prince Alfred Hospital Camperdown New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael S.","family":"Elliott","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James J.","family":"Wykes","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4011-1253","authenticated-orcid":false,"given":"Sydney","family":"Ch'ng","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kerwin F.","family":"Shannon","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carsten E.","family":"Palme","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tsu\u2010Hui (Hubert)","family":"Low","sequence":"additional","affiliation":[{"name":"Department of Head and Neck Surgery Chris O'Brien Lifehouse Camperdown New South Wales Australia"},{"name":"Central Clinical School, Faculty of Medicine and Health Sciences, The University of Sydney Sydney New South Wales Australia"},{"name":"Department of Otolaryngology\u2010Head & Neck Surgery Faculty of Medicine and Health Sciences, Macquarie University Sydney New South Wales Australia"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,7,1]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"crossref","first-page":"2905","DOI":"10.1002\/hed.26335","article-title":"Trends in Parotidectomy Over 30\u2009Years in an Australian Tertiary Care Center","volume":"42","author":"Subramaniam N.","year":"2020","journal-title":"Head & Neck"},{"key":"e_1_2_8_3_1","doi-asserted-by":"crossref","first-page":"843","DOI":"10.1007\/s12105-021-01294-9","article-title":"Metastases of Cutaneous Squamous Cell Carcinoma Seem to Be the Most Frequent Malignancies in the Parotid Gland: A Hospital\u2010Based Study From a Salivary Gland Center","volume":"15","author":"Mayer M.","year":"2021","journal-title":"Head and Neck Pathology"},{"key":"e_1_2_8_4_1","doi-asserted-by":"crossref","first-page":"101","DOI":"10.1002\/jso.21092","article-title":"Parotid and Cervical Nodal Status Predict Prognosis for Patients With Head and Neck Metastatic Cutaneous Squamous Cell Carcinoma","volume":"98","author":"Ch'ng S.","year":"2008","journal-title":"Journal of Surgical Oncology"},{"key":"e_1_2_8_5_1","doi-asserted-by":"crossref","first-page":"1131","DOI":"10.1002\/hed.25561","article-title":"Elective Neck Dissection in Metastatic Cutaneous Squamous Cell Carcinoma to the Parotid Gland: A Systematic Review and Meta\u2010Analysis","volume":"41","author":"Rotman A.","year":"2019","journal-title":"Head & Neck"},{"key":"e_1_2_8_6_1","doi-asserted-by":"crossref","first-page":"1288","DOI":"10.1002\/hed.21332","article-title":"Predicting the Pattern of Regional Metastases From Cutaneous Squamous Cell Carcinoma of the Head and Neck Based on Location of the Primary","volume":"32","author":"Ebrahimi A.","year":"2010","journal-title":"Head & Neck"},{"key":"e_1_2_8_7_1","doi-asserted-by":"crossref","first-page":"749","DOI":"10.1016\/j.clon.2019.08.004","article-title":"Current Role of Radiotherapy in Non\u2010Melanoma Skin Cancer","volume":"31","author":"Veness M. J.","year":"2019","journal-title":"Clinical Oncology"},{"key":"e_1_2_8_8_1","doi-asserted-by":"crossref","first-page":"1275","DOI":"10.1200\/JCO.2017.77.0941","article-title":"Postoperative Concurrent Chemoradiotherapy Versus Postoperative Radiotherapy in High\u2010Risk Cutaneous Squamous Cell Carcinoma of the Head and Neck: The Randomized Phase III TROG 05.01 Trial","volume":"36","author":"Virgilio Porceddu S.","year":"2018","journal-title":"Journal of Clinical Oncology"},{"key":"e_1_2_8_9_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjoto.2022.103374"},{"key":"e_1_2_8_10_1","doi-asserted-by":"crossref","first-page":"21","DOI":"10.1002\/hed.20912","article-title":"Outcomes Following Parotidectomy for Metastatic Squamous Cell Carcinoma With Microscopic Residual Disease: Implications for Facial Nerve Preservation","volume":"31","author":"Gopalakrishna Iyer N.","year":"2009","journal-title":"Head & Neck"},{"key":"e_1_2_8_11_1","doi-asserted-by":"publisher","DOI":"10.1002\/lary.32006"},{"key":"e_1_2_8_12_1","doi-asserted-by":"publisher","DOI":"10.3390\/life12122053"},{"key":"e_1_2_8_13_1","doi-asserted-by":"crossref","first-page":"1557","DOI":"10.1056\/NEJMoa2209813","article-title":"Neoadjuvant Cemiplimab for Stage II to IV Cutaneous Squamous\u2010Cell Carcinoma","volume":"387","author":"Gross N. D.","year":"2022","journal-title":"New England Journal of Medicine"},{"key":"e_1_2_8_14_1","doi-asserted-by":"crossref","first-page":"804","DOI":"10.1017\/S0022215121001857","article-title":"The Impact of Radical Parotidectomy With Immediate Facial Nerve Reconstruction: A Quality\u2010of\u2010Life Measure","volume":"135","author":"Subramaniam N.","year":"2021","journal-title":"Journal of Laryngology and Otology"},{"key":"e_1_2_8_15_1","doi-asserted-by":"crossref","first-page":"1674","DOI":"10.1111\/ans.18336","article-title":"Outcomes of Immediate Facial Nerve Reanimation With Nerve Transfer for Facial Nerve Neoplasm\u2010Induced Paralysis: A Retrospective Review","volume":"93","author":"Shein G.","year":"2023","journal-title":"ANZ Journal of Surgery"},{"key":"e_1_2_8_16_1","doi-asserted-by":"crossref","first-page":"106601","DOI":"10.1016\/j.oraloncology.2023.106601","article-title":"Improving the Oral Function of Patients With Upper and Lower Lip Tensor Fascia Lata Slings for Patients With Flaccid Facial Nerve Palsy","volume":"147","author":"Charters E.","year":"2023","journal-title":"Oral Oncology"},{"key":"e_1_2_8_17_1","doi-asserted-by":"crossref","first-page":"417","DOI":"10.1002\/hed.10063","article-title":"Significance of Clinical Stage, Extent of Surgery, and Pathologic Findings in Metastatic Cutaneous Squamous Carcinoma of the Parotid Gland","volume":"24","author":"O'Brien C. J.","year":"2002","journal-title":"Head & Neck"},{"key":"e_1_2_8_18_1","doi-asserted-by":"crossref","first-page":"1109","DOI":"10.1002\/hed.28005","article-title":"The Impact of Preoperative Facial Nerve Weakness and Facial Nerve Outcomes in the Management of Patients With Parotid Metastases of Cutaneous Squamous Cell Carcinoma","volume":"47","author":"Lin V.","year":"2025","journal-title":"Head & Neck"},{"key":"e_1_2_8_19_1","doi-asserted-by":"crossref","first-page":"847","DOI":"10.1001\/jamaoto.2023.1729","article-title":"Outcomes of Treatment With Neoadjuvant Cemiplimab for Patients With Advanced, Resectable Cutaneous Squamous Cell Carcinoma of the Head and Neck: Secondary Analysis of a Phase 2 Clinical Trial","volume":"149","author":"Ferrarotto R.","year":"2023","journal-title":"JAMA Otolaryngology. Head & Neck Surgery"},{"key":"e_1_2_8_20_1","doi-asserted-by":"crossref","first-page":"9514","DOI":"10.1200\/JCO.2024.42.16_suppl.9514","article-title":"A Phase 2 Study of De\u2010Escalation in Resectable, Locally Advanced Cutaneous Squamous Cell Carcinoma (cSCC) With the Use of Neoadjuvant Pembrolizumab: De\u2010Squamate","volume":"42","author":"Ladwa R.","year":"2025","journal-title":"Journal of Clinical Oncology"},{"key":"e_1_2_8_21_1","doi-asserted-by":"crossref","first-page":"365","DOI":"10.1002\/hed.21743","article-title":"Metastatic Head and Neck Cutaneous Squamous Cell Carcinoma: Defining a Low\u2010Risk Patient","volume":"34","author":"Ebrahimi A.","year":"2012","journal-title":"Head & Neck"}],"container-title":["Head & Neck"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70354","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/full-xml\/10.1002\/hed.70354","content-type":"application\/xml","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1002\/hed.70354","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,2]],"date-time":"2026-07-02T01:50:23Z","timestamp":1782957023000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1002\/hed.70354"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7,1]]},"references-count":20,"alternative-id":["10.1002\/hed.70354"],"URL":"https:\/\/doi.org\/10.1002\/hed.70354","archive":["Portico"],"relation":{},"ISSN":["1043-3074","1097-0347"],"issn-type":[{"value":"1043-3074","type":"print"},{"value":"1097-0347","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7,1]]},"assertion":[{"value":"2025-11-22","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-06-01","order":2,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-07-01","order":3,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}],"article-number":"hed.70354"}}