A 62-year-old man comes to the physician for evaluation of an increasing right-sided cheek swelling for 2 years. He has had recurrent right-sided oral ulcers for the past 2 months. He has smoked a pack of cigarettes daily for 30 years. He drinks a beer every night. His temperature is 37.1·c (98.B'F), pulse is 71 min, respirations are 14,'min, and blood pressure is 129 83 mm Hg. Examination shows a mild, nontender swelling above the angle of the right jaw. There is no overlying erythema or induration. There are multiple shallow ulcers on the right buccal mucosa and mandibular marginal gingiva. There IS no lymphadenopathy. Ultrasound shows a soft tissue mass in the parond gland. An ultrasound-guided biopsy of the ma.ss confirms the diagnosos of parotid adenoid cystic carcinoma. A right-sided total parotidectomy is scheduled.