Management of the Neck Regarding the Novel Oncological Entities of the Salivary Glands

Background/Objectives: The 2022 World Health Organization (WHO) Classification of Head and Neck Tumors introduced six novel salivary gland entities: four benign (sclerosing polycystic adenoma, keratocystoma, intercalated duct adenoma and hyperplasia, striated duct adenoma) and two malignant (microsecretory adenocarcinoma and sclerosing microcystic adenocarcinoma). Owing to their rarity, no consensus guidelines exist for cervical lymph node management. This review appraises the evidence on the indications for neck dissection and adjuvant regional radiotherapy in these entities. Methods: PubMed, Google Scholar, Web of Science, and Scopus were searched in English and Greek using Medical Subject Headings (MeSH) terms and keywords for each entity, “neck dissection”, and “salivary gland tumor”. Case reports, case series, retrospective studies, and clinical practice guidelines were eligible; 63 publications were included. Results: No nodal or distant metastasis was reported in any case of the four benign entities. Among published microsecretory adenocarcinomas (14 salivary and 9 cutaneous cases), nodal metastasis occurred only in one high-grade transformed case; none of the 23 published sclerosing microcystic adeno-carcinomas showed nodal involvement. The European Society for Medical Oncology (ESMO), the American Society of Clinical Oncology (ASCO), and the French Network of Rare Head and Neck Tumors (REFCOR) agree on complete surgical resection but diverge on the clinically node-negative neck in low-grade tumors. Two neck management algorithms were formulated, for parotid and minor salivary gland tumors. Conclusions: Neck dissection is not indicated for the novel benign entities. For the low-grade malignant entities, neck management should be guided by tumor site and adverse features; the proposed algorithms, based on ESMO, ASCO, and REF-COR guidance, may support decisions until further evidence is available.