Modes of Spread of Cancer of Skin

Mohs, Frederic E.

doi:10.1001/archderm.1952.01530290003001

Cited by 169 publications

(133 citation statements)

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“…This space has minimal resistance for extension to occur and may serve as a potential pathway for skin carcinomas of the head and neck region to enter the subarachnoid space of the cranial cavity. 1 Perineural invasion usually occurs in an antegrade (centripetal) fashion, because tumor is more likely to enter the nerve sheath at 1 of the smaller peripheral nerve branches. In some patients, retrograde (centrifugal) extension has been observed and may result when perineural tumor encounters a ganglion and reverses direction along another peripheral branch of the ganglion.…”

Section: Methodsmentioning

confidence: 99%

“…[2][3][4][5] Typically, squa-mous cell carcinoma (SCC) has a higher incidence of PNI than basal cell carcinoma, with reported rates ranging from 2.5% to 14% in SCC 6,7 compared with 1% in basal cell carcinomas. 1,8 The presence of PNI in patients with SCC often is associated with aggressive clinical behavior, an increased risk of recurrence and metastasis, and a poorer prognosis. 5,[9][10][11] Risk factors for PNI in SCC include male sex, tumor size >2 cm, midfacial tumor location, recurrent tumor, less well differentiated histologic subtypes, and significant subclinical extension.…”

Section: Methodsmentioning

confidence: 99%

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What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion?

Han

Ratner

2007

Cancer

142

108

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BACKGROUND.Perineural invasion (PNI) in cutaneous squamous cell carcinoma (SCC) is infrequent, occurring in 2.5% to 14% of patients, but it is important prognostically, because it carries an increased risk of recurrence and metastasis. Although both excision and Mohs micrographic surgery (MMS) are used to treat SCC with PNI, postoperative radiation therapy (XRT) often is recommended to minimize the risk of recurrence. To date, the effectiveness of adjuvant XRT in this setting has not been determined definitively.METHODS.The authors evaluated the effectiveness of adjuvant XRT in treating SCC with PNI by performing a thorough literature review.RESULTS.For SCC with PNI, the local control rate after MMS with or without XRT was from 92% to 100% compared with a control rate from 38% to 100% after standard excision with or without XRT. A better prognosis was associated with negative pretreatment magnetic resonance imaging or computed tomography findings than with positive radiographic evidence of PNI. Primary SCC with PNI was associated with better local control than recurrent SCC with PNI. When treatment outcomes were stratified by PNI type, SCC with microscopic PNI and SCC with extensive PNI had local control rates from 78% to 87% and from 50% to 55%, respectively. Adjuvant XRT was associated in selected patients with 100% local control.CONCLUSIONS.Few studies addressed the effectiveness of adjuvant XRT in patients who have SCC with PNI. Although XRT has been established as an adjuvant treatment for selected patients, the extent of nerve involvement by tumor, particularly in the setting of other high‐risk features, may be helpful in defining its role. In the future, a multicentered, prospective, randomized clinical trial will be needed to assess the true efficacy of adjuvant XRT in the treatment of patients with SCC and PNI. Cancer 2007 © 2007 American Cancer Society.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion?

Han

Ratner

2007

Cancer

142

108

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“…Clinical signs do not reliably predict the presence on extent of pemineumal spread [6,7,25,26]. Because ofthis, and because of the possible role of penneumal tumor spread in treatment failure, all patients with malignant lesions of the masticator space or ptemygopalatine fossa should undergo complete cranial nerve V imaging.…”

Section: Resultsmentioning

confidence: 99%

The radiologic assessment of trigeminal neuropathy

Hutchins

Harnsberger

Hardin

et al. 1989

American Journal of Roentgenology

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“…1 One investigator has proposed that the necessary and sufficient condition for PNI is the presence of unequivocal tumor cells inside the perineurium. 1 Possible contributors to PNI include nutritional factors associated with a nerve's vascular supply 2 and, at least for basal cell carcinoma (BCC), previous radiotherapy (RT). mammary carcinoma growing along the facial nerve.…”

Section: Conclusion Previous Reportsmentioning

confidence: 99%

Perineural spread of cutaneous malignancy to the brain

Fowler

Crocker

Johnstone

2005

Cancer

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BACKGROUNDThe retrospective analysis was performed to investigate the role of stereotactic radiotherapy (SRT) techniques for patients with intracranial perineural spread (PNS) of a primary cutaneous malignancy.METHODSFive patients were identified who received SRT from 1993 to 2003 for cutaneous malignancies with intracranial PNS to the cavernous sinus (n = 3) or Meckel's cave (n = 2). Patients were treated with GammaKnife stereotactic radiosurgery (n = 2), linear accelerator (linac)‐based fractionated SRT (n = 2), or linac‐based stereotactic radiosurgery (n = 1).RESULTSThe median overall survival (OS) periods from diagnoses of cutaneous malignancy and intracranial PNS were 63.0 months (range, 22.0–102.2 months) and 25.5 months (range, 22.0–55.2 months), respectively. The median OS from SRT was 24.2 months (range, 19.5–53.2 months). One patient was alive and without evidence of disease at 53 months of follow‐up. The median durations of local and regional control from SRT were 19.5 months (range, 1.5–53.2 months) and 7.0 months (range, 1.5–53.2 months), respectively.CONCLUSIONSPrevious reports generally have recommended that patients with intracranial PNS receive palliative external‐beam radiotherapy. Results from the current study suggest that some of these patients may have prolonged survival, or even may be cured. Judicious use of SRT should be considered in their management. Cancer 2005. © 2005 American Cancer Society.

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Modes of Spread of Cancer of Skin

Cited by 169 publications

References 14 publications

What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion?

What is the role of adjuvant radiotherapy in the treatment of cutaneous squamous cell carcinoma with perineural invasion?

The radiologic assessment of trigeminal neuropathy

Perineural spread of cutaneous malignancy to the brain

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