Adjunctive radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion

Abstract

Perineural invasion is a feature associated with significantly poorer outcomes when present in cutaneous squamous cell carcinoma (CSCC). The incidence of this subset of CSCC continues to rise in the US, as does the confusion surrounding exactly how it should be managed. While management typically involves excision, considerable debate exists as to the appropriate use of adjuvant radiotherapy (ART) in addition to excision. This article reviews the current relevant evidence for the use of ART.

Advanced cutaneous squamous cell carcinoma: real world data of patient profiles and treatment patterns

“…4 Radiotherapy can be used in the adjuvant setting or for inoperable tumours or metastases. [8][9][10][11] In locally inoperable or distant metastatic SCC, anti-PD-1 inhibitors might be an option to consider, particularly after approval that is expected in 2019. [12][13][14][15][16] Epidermal growth factor receptor inhibitors such as cetuximab or erlotinib as well as various chemotherapies are also used, but there is no standard regime and treatment is often limited in old comorbid patients.…”

Podoplanin expression in cutaneous head and neck squamous cell carcinoma—prognostic value and clinicopathologic implications

“…This applies to the whole population of patients with cHNSCC, however, the incidence of regional lymph node metastases in patients with high risk tumors referred to specialized treatment centers is 10–20% 12, 13. Several clinicopathologic factors that increase the patients risk of developing regional lymph node metastases in cHNSCC such as large size >2 cm, depth of invasion >4 mm, incomplete excision, desmoplastic lesions, presence of perineural invasion, lymphangiosis carcinomatosa and immunosuppression have been described 4, 10, 14. The majority of immunocompentent patients with a non‐recurrent, small (2 < cm) and superficial growth pattern (depth of invasion <3 mm) are at low risk for developing regional lymph node metastases, whereas patients exhibiting one more of the above mentioned risk factors have a higher risk of regional lymph node involvement 13.…”

A rare case of acral cutaneous squamous cell carcinoma with multiple late cutaneous metastases and extensive neurotropic spread

“…Because of the aggressive nature of clinical PNI, it is recommended to treat with Mohs resection to clear nerve margins and postoperative salvage radiotherapy. 10 Our patient was offered referral to a regional cancer center for Mohs micrographic surgery but declined because of geographic limitations. He also declined further dissection by the general surgeon, magnetic resonance imaging of the left arm and shoulder to assess nerve involvement, and a positron emission tomography–computed tomography scan to rule out metastasis.…”