Metastases to parotid nodes.

The differential diagnosis of masses in the preauricular and retromandibular regions includes a number of diseases in addition to primary tumors of the parotid. The lesions most commonly misdiagnosed as parotid tumors are intraparotid lymph nodes involved with inflammatory or neoplastic disease. Metastatic tumors in parotid nodes are unusual but must be considered. We present 12 patients with isolated metastases to parotid lymph nodes. Nine of the patients had primary tumors in the local afferent lymphatic bed. Three patients had metastases from unknown or distant sites. The majority of tumors that metastasize to the parotid are of cutaneous origin. Six of the patients had squamous cell carcinomas, three had adenocarcinomas, two melanomas and one a small cell carcinoma. The treatment of parotid metastases from local tumors is surgical removal of the parotid and associated regional nodes with postoperative irradiation therapy in certain instances. Management of the facial nerve should follow those principles appropriate for primary parotid tumors.