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Introduction and importance: Squamous cell carcinoma (SCC) accounts for approximately 20% of nonmelanoma skin cancers, with a significant proportion arising in the head and neck region. Up to 5% of these lesions’ present nodal metastases, particularly to the parotid gland, attributed to the extensive lymph nodes in and around the gland. Treatment typically involves surgical resection, including cervical lymph node dissection, with adjuvant radiation therapy recommended in select cases. Reconstruction using a microsurgery-assisted free anterolateral thigh flap is valuable in complex cases such as SCC with parotid metastasis, providing optimal reconstruction outcomes and improving patient quality of life.

Case presentation: We presented a 68-year-old woman with squamous cell carcinoma (SCC) in the left parotid gland and metastasis. The patient had a history of SCC in the left zygomatic region. The parotid lesion exhibited rapid growth and was associated with various symptoms, including eye pain, hearing loss, tinnitus, and headache.

Discussion: Treatment involved left extended total parotidectomy, ipsilateral supraomohyoid neck dissection, and reconstruction with a microsurgery-assisted free anterolateral thigh flap.

Conclusion: Comprehensive care, from early diagnosis to skilled surgery, is vital for improving outcomes in squamous cell carcinoma, particularly with parotid metastases.