Perineural invasion in skin cancer of the head and neck

Ampil, Federico L.; Hardin, John C.; Peskind, Steven P.; Stucker, Fred J.

doi:10.1016/0278-2391(95)90496-4

Cited by 70 publications

(75 citation statements)

References 14 publications

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“…All 3 of the patients in that study who received adjuvant XRT had 100% local control with no evidence of disease at follow-up between 18 months and 201 months. 26 All 6 patients who did not receive adjuvant XRT in that study also had 100% local control, suggesting that aggressive surgical treatment of advanced SCC patients, with or without adjuvant XRT, may achieve long-term disease control as long as the tumor is recognized and treated adequately prior to its entry into the cranial cavity.…”

Section: Discussionmentioning

confidence: 86%

“…21 The results reported by Ampil et al, who performed aggressive surgery with or without XRT for patients with extensive PNI, differed somewhat from the other studies, with a local control rate of 66.7% and 100% 5-and 10-year disease-free survival rates. 26 Later studies, which divided patients into groups with microscopic or extensive PNI, demonstrated that patients who had microscopic PNI had local control rates of 78% to 87% after treatment compared with patients who had extensive PNI (local control rates, 50-55%) 10,16,20,25 (Table 2). Table 3 summarizes local control rates of patients who had SCC with PNI based on their imaging results.…”

Section: Resultsmentioning

confidence: 99%

“…Although the authors cited survival rates of 33% at 5 years and 22% at 10 years, it is important to note that no patient died of recurrent cancer and that no patient who died had any residual skin cancer, for an overall disease-free survival rate of 100%. 26 The study by Ampil et al also was unique, because it stratified treatment outcomes based on the use of adjuvant XRT. The decision to treat with XRT was related to the size of the tumor (1 patient had a tumor that measured 12.5 cm, the largest in the series) and to evidence of tumor found at the deep margin of resection close to the skull base (2 patients had tumor found in the infraorbital area of the skull).…”

Section: Discussionmentioning

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

143

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: Discussionmentioning

confidence: 86%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

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

143

108

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“…Our cases follow the typical characteristics for SCC with PNI: older patients with recurrent and/or multiple incompletely excised SCCs (tables 1, 2) [2,8,9,10,11,12,13,14,15,16,17]. Most of our patients were 60 years or older, and an average of four excisions were necessary for complete removal.…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Verburg¹,

Lang²,

Mühlstädt

et al. 2014

Dermatology

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Background: Perineural invasion (PNI) in cutaneous squamous cell carcinoma (SCC) is considered to be a negative prognostic factor. A lot of uncertainty remains regarding the classification, diagnosis, treatment and prognosis of SCC with PNI. Objective: To describe typical courses of SCC with PNI and associated findings in order to suggest an optimized diagnostic and therapeutic approach. Methods: We present eight cases of SCC with PNI, considering patient and tumor characteristics, histology, treatment and clinical course regarding local recurrence and metastasization. Results: SCC patients with PNI have a higher rate of local recurrences and greater risk for metastasization than SCC patients without PNI. Age ranged from 68 to 77 years, 6 patients were male and 2 female, with all tumors localized on the head. Three patients had chronic lymphocytic leukemia. Conclusion: Based on the data of this series and the current literature, we make suggestions for better diagnostic and therapeutic management.

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“…If a named nerve is involved, RT to the ganglia or the base of skull is appropriate. 16,[32][33][34] Veness considers recurrent intracranial disease to be incurable, but favors RT to doses Ͼ 50 Gy for palliating local symptoms. 1,12 He has advocated treatment of nerves within the orbit, the cavernous sinus, and sometimes the middle cranial fossa and brainstem.…”

Section: Discussionmentioning

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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Perineural invasion in skin cancer of the head and neck

Cited by 70 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?

Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Perineural spread of cutaneous malignancy to the brain

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