Background <p>Localisation of metastatic squamous cell carcinoma (SCC) often poses intraoperative challenges. There is limited description of surgical practices to address these difficulties in the literature. Low-frequency ultrasound use intraoperatively may enhance tumour detection and facilitate complete resection.</p> Case presentation <p>We present the case of a 78-year-old male with right-sided intra-parotid metastatic SCC requiring surgical excision. This was completed under intraoperative ultrasound scan guidance. Preoperative whole-body PET-CT and MRI of the head were inadequate for confirming accurate lesion localisation regarding the depth of invasion and facial nerve involvement. Intraoperative ultrasound performed by a consultant radiologist guided the metastasectomy by confirming lesion boundaries, navigating safe excision by sparing the facial nerve branches and facilitating the avoidance of more radical resection. Full resection with no residual disease was confirmed intraoperatively with the ultrasound.</p> Conclusion <p>We propose using ultrasound guidance intraoperatively to aid localisation and excision of metastatic disease in anatomically challenging sites.</p>