This is a retrospective analysis of 60 patients with previously untreated metatypical basal cell (3 patients) or squamous cell (57 patients) carcinoma of the skin, metastatic to the parotid area. All patients had a minimum 2-year follow-up, and 43% had a minimum 5-year follow-up. Treatment was surgery alone (8 patients), irradiation alone (16 patients), or planned combined surgery and irradiation (36 patients). The ultimate rates of control of disease in the parotid area were surgery alone, 5 of 8 (63%); irradiation alone, 6 of 13 (46%); planned combined surgery and irradiation, 32 of 36 (89%). In the combined-treated group, all 4 recurrences were in patients who had positive surgical margins and gross involvement of the facial nerve. In patients with negative surgical margins, without involvement of the facial nerve, who had combined treatment, the control rate was 100%. Of the surgery-alone group, only 1 patient ultimately had the disease controlled and retained a functioning facial nerve.