Impact of radiographic findings on prognosis for skin carcinoma with clinical perineural invasion

Abstract

Background The nuclear weapons industry has long been known as a source of beryllium exposure. Methods A total of 1,004 former workers from a nuclear weapons assembly site in the Midwest were screened for sensitization to beryllium (BeS). The screenings were part of the Department of Energy (DOE) Former Worker Program established in 1996. Results Twenty‐three (2.3%) workers were found sensitized to beryllium and this prevalence was comparable to other DOE sites. Occasional, direct exposure to beryllium through machining and grinding of copper–beryllium (Cu–Be) 2% alloy tools was found to increase the risk of sensitization compared to background exposure (OR = 3.83; 95% CI: 1.04–14.03) with a statistically significant trend (P = 0.03) revealing that particular jobs are associated with sensitization. Exposure potential in this study was estimated based on job titles and not personal exposure information. Conclusions These results confirm the need to screen workers using beryllium alloy tools in other industries and for consideration of altering work practices. Am. J. Ind. Med. 54:194–204, 2011. © 2010 Wiley‐Liss, Inc.

Skin Cancer of the Head and Neck With Perineural Invasion

“…19 Magnetic resonance imaging is the most sensitive radiographic study to detect and define the extent of PNI. 17 Two examples of the radiographic findings in 2 patients with clinical PNI are depicted in Figures 1 and 2. It is rare to observe radiographic evidence of PNI on an asymptomatic patient.…”

“…16 Radiographic evidence of PNI includes enlargement or abnormal enhancement of the nerve, obliteration of the fat plane surrounding the nerve, and/or erosion or enlargement of the related foramen. 17 Abnormal enhancement implies diffuse enhancement of the nerve with loss of the distinction between the nerve and the perineural vascular plexus. 17 Patients with PNI have an increased risk of metastases to the regional lymph nodes.…”

“…17 Abnormal enhancement implies diffuse enhancement of the nerve with loss of the distinction between the nerve and the perineural vascular plexus. 17 Patients with PNI have an increased risk of metastases to the regional lymph nodes. 2,7 Thus, patients should undergo contrast-enhanced computed tomography to evaluate the regional nodes as well as to assess bone invasion.…”

“…14 Patients with PNI may be asymptomatic (incidental) or present with cranial nerve deficits (clinical) because of tumor invasion. 16,17 It is likely that the majority of patients have incidental PNI and that a relatively modest subset presents with clinical PNI. The initial symptoms of PNI are often subtle and may consist of a feeling of ants crawling underneath the skin (formication).…”

Perineural Tumor Spread

“…1 In addition, in symptomatic patients the lesions limited to peripheral nerves or with minimal/moderate PNS tumor burden have a better local control rate, although a similar survival rate, compared with patients who have central or macroscopic disease. 3,4 This pattern of neoplastic spread can be clinically unsuspected while it conveys the tumor cells beyond the surgical and radiation fields of treatment. Therefore, if PNS is undetected or its extent is underestimated by imaging techniques, treatment will probably not control the disease.…”