Staging and Treatment of Melanoma in the Parotid Gland

Staging Classification

Melanoma involving the parotid gland is classified as Stage III disease when it represents regional lymph node metastasis from a cutaneous primary, or Stage IV if it represents distant metastasis from a non-head-and-neck primary 1, 2, 3
The American Joint Committee on Cancer recommends that when melanoma in the parotid gland represents metastasis from a head and neck cutaneous or mucosal primary, it is classified as Stage III because the parotid contains lymph nodes that serve as regional drainage for head and neck sites 1, 4

The National Comprehensive Cancer Network recommends that the number of positive lymph nodes is the most significant prognostic factor in Stage III disease, with patients having metastasis in only one lymph node having significantly better outcomes 1, 4
The American College of Radiology recommends that MRI with contrast provides optimal delineation of parotid masses and assessment of perineural spread, facial nerve involvement, and deep tissue extension 6
The National Comprehensive Cancer Network recommends that following surgical resection of Stage III disease, options include observation, clinical trial enrollment, or interferon-alfa (category 2B recommendation) 4
The National Comprehensive Cancer Network recommends that for Stage IIIC disease with multiple nodes involved or extranodal extension, radiation therapy to the nodal basin should be considered 4
The American College of Radiology recommends that ultrasound can detect and characterize superficial parotid masses and guide fine-needle aspiration, but is insufficient for deep lobe lesions and cannot assess perineural spread or bone invasion 6

The National Comprehensive Cancer Network recommends that complete history and physical examination must focus on identifying a potential primary site, including thorough skin examination of the entire head and neck, scalp, and examination of conjunctivae and oral mucosa 4, 5
The National Comprehensive Cancer Network recommends that serum LDH should be obtained as it is an independent predictor of poor outcome in metastatic melanoma 5

The National Comprehensive Cancer Network recommends that wide excision of the primary melanoma (if identified) with appropriate margins (1 cm for tumors ≤2 mm thick, 2 cm for tumors >2 mm thick) combined with complete lymph node dissection is the standard treatment for Stage III disease with clinically positive parotid nodes 4
The National Comprehensive Cancer Network recommends that facial nerve preservation should be attempted when a dissection plane can be created between tumor and nerve, unless the nerve is grossly involved or preoperative facial nerve dysfunction is present 7