Perineural invasion in squamous cell skin carcinoma of the head and neck

Goepfert, Helmuth; Dichtel, William J.; Medina, Jesús E.; Lindberg, Robert D.; Luna, Mario D.

doi:10.1016/0002-9610(84)90385-4

Cited by 392 publications

(400 citation statements)

References 15 publications

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“…10,14,16,20,21,24,25 Patients who underwent MMS with or without XRT achieved superior local control rates of 92% to 100%. 13,15,18,24 Early studies, which consisted almost entirely of patients who were symptomatic or who had imaging-positive disease (ie, clinical PNI) demonstrated local control rates at the lower end of the spectrum, ranging from 38% to 53%, 14,21,24 with 1 reported 5-year survival rate of 33%. 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.…”

Section: Resultsmentioning

confidence: 99%

“…In contrast, patients with recurrent SCC with PNI exhibited control rates from 11% to 50%, again irrespective of their treatment regimen. 14,21 When the extent of PNI within primary and recurrent SCCs was stratified into microscopic versus extensive disease, the local control rate for patients with microscopic PNI was 79%, and the local control rate of patients with extensive PNI was from 45% to 47% regardless of whether the disease was primary or recurrent.…”

Section: Resultsmentioning

confidence: 99%

“…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. [11][12][13][14][15][16] Patients with SCC who have risk factors for PNI require an organized approach to their evaluation, because early detection of PNI maximizes the chance of effective treatment. Pretreatment evaluation of these high-risk patients consists of a thorough history and physical examination.…”

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

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: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

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

143

108

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“…26 Perineural invasion occurs in less than 1% of basal cell carcinomas, 18,27 but in about 3-14% of squamous cell carcinomas. 17,28 It is more common in lesions of the forehead and brow 29,30 and with aggressive cell types. 23,24,28,31 Clinical signs…”

Section: Indicationsmentioning

confidence: 99%

“…17,28 It is more common in lesions of the forehead and brow 29,30 and with aggressive cell types. 23,24,28,31 Clinical signs…”

Section: Indicationsmentioning

confidence: 99%

Orbital exenteration for invasive skin tumours

Tyers

2006

Eye

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Orbital exenteration aims at local control of disease invading the orbit that is potentially fatal or relentlessly progressive. Of all exenterations presenting to ophthalmologists, 40-50% are required for tumours in the eyelid or periocular skin. 99% of these are basal cell carcinomas and 4-6% each are squamous cell carcinomas or sebaceous gland carcinomas. Orbital invasion results in progressive fixation of the tumour to bone and reduced ocular motility. Perineural invasion of branches of the trigeminal nerve leads to numbness or pain, and that the facial nerve, to weakness. Biopsy identifies the cell type and the presence of perineural invasion. CT and MRI scanning help in the assessment of tumour spread within the orbit. Management should be in collaboration with an oncologist. Exenteration may be totalthe removal of all orbital contents-or lidsparing if the tumour is placed posteriorly. The socket may be allowed to heal by granulation or lined with a split skin graft or local flap. Complications may be seen following 20-25% of exenterations and include fistulae, tissue necrosis, exposed bone, and infection. Incomplete clearance of tumours occurs in about 38% of total exenterations and 17% of subtotal. The overall 5-year survival is 55-65%, but significantly worse if there was perineural spread. Facial prostheses may be mounted on glasses or secured with tissue glue or osseointegrated implants. Excellent cosmetic results can be achieved but many patients prefer to wear a patch.

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