Facial Nerve Preservation in Advanced Facial Cutaneous Squamous Cell Carcinoma With Parotid Invasion: A Case Report

To report the management of an advanced cutaneous squamous cell carcinoma (SCC) with parotid gland invasion, emphasizing surgical treatment with facial nerve preservation and reconstruction using a supraclavicular fasciocutaneous flap. A 64-year-old man presented with a rapidly growing ulcerated lesion in the right malar region measuring approximately 5.0 cm × 4.0 cm. Imaging suggested parotid gland involvement without regional lymph node metastasis (cT3N0M0), which was subsequently confirmed histopathologically. The patient underwent wide local excision and parotidectomy extending to the deep lobe following identification of a positive deep margin on frozen-section analysis, while preserving the facial nerve. Reconstruction was performed using a supraclavicular fasciocutaneous flap. Histopathological examination confirmed a moderately differentiated SCC with parotid gland invasion and clear surgical margins. Adjuvant radiotherapy was subsequently administered. Advanced cutaneous SCC of the face requires multidisciplinary management. Radical surgical resection with intraoperative margin assessment may allow preservation of critical structures such as the facial nerve, while the supraclavicular fasciocutaneous flap remains a reliable reconstructive option for extensive cervicofacial defects.