Treating Malignant Head and Neck Paragangliomas

Some Considerations in Treating Malignant Head and Neck Paragangliomas: To the Editor As academic physicians with an interest in pheochromocytoma/paraganglioma, we read with great interest the article by McCrary et al characterizing malignant head and neck paragangliomas (HNPGLs). The authors used the paraganglioma cohort from an academic tertiary cancer center diagnosed between 1963 and 2018. They found that the prevalence of malignant HNPGLs was 6 of 70 (9%), with 5 of 6 patients carrying the succinate dehydrogenase subunit B (SDHB) mutation. They suggested that patients with paragangliomas should undergo genetic testing, and owing to the difficulty in diagnosing malignant HNPGL prior to surgery, selective neck dissection should be performed during an initial resection. The data presented here are informative, and we congratulate the authors on this effort, yet we have a few concerns.