Parotid cancer: a rational basis for treatment.

Parotid gland cancers are uncommon neoplasms whose management is complicated by their variable histopathology, their equally variable clinical course, and the intricate relationship of the facial nerve to the parotid gland and potential threat to the muscles of facial expression. In order to expand the limited familiarity with this unusual cancer that any single surgeon may acquire, a review is presented of factors influencing survival, including histopathology, lymph node metastasis, facial nerve palsy, skin involvement, size (stage), recurrence, pain, deep lobe and distant metastasis. The personal experiences of the author, experiences at the University of Virginia, and those in the literature were reviewed to derive the principles of treatment based on the TNM staging system and histopathologic diagnosis.