Primary squamous cell carcinoma (PSCC) is a unique entity of the parotid gland neoplasms.The scarce occurrence of the true primary parotid SCC, consisting of only 0.1% - 3.4% of all parotid malignancies, accounts for the restricted data on the subject [1].
Epidemiology of this aggressive tumor shows that it has a male: female ratio of 2:1 and presents in elderly individuals with a mean age of presentation at 64 years [7].
PSCC does not exhibit any specific growth model or clinical characteristics that could differentiate it from its other counterparts [5].The typical presenting complaints of the individuals are a parotid mass, neck mass and facial paralysis in 17-33% of the cases along with pain varying between 8-33%. Moreover the mass may be fixed to the skin above or underlying structures [8].
This neoplasm originates from the ductal epithelium secondary to chronic inflammation consequently leading to metaplasia that turns into invasive squamous cell carcinoma [9].The histological appearance shows intracellular keratinization, intercellular bridging, and keratin pearl formation with scanty mucus secretion. However, there is nothing to differentiate these squamous cell carcinomas from those originating from other areas. [6].
The histology of the parotid malignancies therefore contribute significantly to the patient’s survival while fine needle aspiration cytology remains the principal choice of investigation in major salivary gland tumors [7].Total parotidectomy and superficial parotidectomy with facial nerve conservation are the ideal form of treatment for primary SCC of the parotid gland and other classes of high-grade parotid carcinomas with the extent of surgery directly related to the extent of cancer [5].
Furthermore another population based study analyzed 191 patients from 1988-1998 with SCC of the major salivary glands showing that SCC had one of the worst outcomes along with a 5-year actuarial survival of 46.1% [10]. Previous studies have shown that involvement of clinically palpable nodes in the neck worsened prognosis in the primary SCC of the parotid gland [11]. Moreover, age more than 60 years, ulceration of the skin, deep fixation and facial nerve involvement are other factors associated with significantly poor prognosis. [7].
The devastating outcome in this case could be explained secondary to delay in seeking medical care and our patient’s financial stresses which proved to be fatal for him. Overall delay in seeking medical care, lack of awareness and financial problems are the major factors in our country for high rates of morbidity and mortality.