How would you utilize adjuvant radiation therapy in a patient with a cutaneous spindle cell neoplasm of the scalp metastatic to the parotid gland?

A lot will depend upon how “total” the parotidectomy really was. If the deep lobe was resected and the facial nerve sacrificed with totally negative margins I would be content to utilize careful observation with no postoperative radiation therapy to the parotid bed. If only a superficial parotidectomy was done, facial nerve still intact, I would treat the parotid bed and level I and II cervical nodes. The generally accepted postoperative dose would be 60 Gy in 30 fractions.

Mohs surgery on the primary lesion performed by a competent dermatologist inherently implies negative margins; therefore I would not treat the scalp lesion postoperative. As a further measure, if the patient had sufficient time to develop metastatic disease to the paroti...