Stereotactic Post-operative Radiotherapy for Intraparotid Metastatic Cutaneous Squamous Cell Carcinoma

Inclusion criteria * Age ≥ 18 years * Patient able to provide informed consent * Eastern Cooperative Oncology Group (ECOG) performance status 0-2 * Patient is a candidate for curative intent treatment * Patient is able to comprehend English adequately to complete patient reported outcome questionnaires * Biopsy-confirmed cutaneous SCC * Definitive resection of a primary cutaneous tumor within the head and neck * Tumor stage T1-T4 (AJCC 8th edition); or tumor stage unknown (T0/Tx) with a positive intraparotid, peri-parotid or cervical node that is assumed to be from a head and neck cutaneous SCC by the treating oncologist * Nodal stage N1-N3 (AJCC 8th edition) * At least 1 indication for adjuvant radiation, including: * T3 or T4 tumor stage * Lymphovascular invasion (LVI) * Perineural invasion (PNI) * Positive or close (≤ 3 mm) margin * ≥ 1 positive intraparotid, peri-parotid or cervical lymph node * Multiple local recurrences or multi-focal disease * Neoadjuvant or adjuvant immunotherapy is allowed Exclusion criteria * Definite metastatic disease at diagnosis * Pregnant or breastfeeding women * Significant health conditions or contraindications to receiving surgery and radiation * History of previous head and neck cancer within 5 years, except for localized skin cancers (i.e. no nodal or distant spread) * Prior head and neck radiation involving the ipsilateral parotid or neck. However, prior radiation to the index skin cancer that has led to the parotid nodal disease being treated on this trial is allowed, as long as there is no overlap, or inconsequential overlap, in the judgement of the treating oncologist. * Indications for contralateral neck radiation (i.e. contralateral or bilateral lymph nodes) * Previous invasive malignancy within 5 years, unless controlled with no evidence of disease