Perineural Invasion of Cutaneous Malignancies

Feasel, Adrienne M.; Brown, Tricia J.; Bogle, Melissa A.; Tschen, Jaime A.; Nelson, Bruce R.

doi:10.1046/j.1524-4725.2001.00330.x

Cited by 108 publications

(174 citation statements)

References 132 publications

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“…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. [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.…”

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

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: 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

143

108

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“…Cancer cells travel along the plane of least resistance, which is the path created by the pre-existing nerve [156]. Perineural invasion is common in pancreatic, prostatic, squamous cell, and basal cell carcinoma, and in melanoma [157]. Approximately 30% of the patients suffering from colon cancer have perineural invasion [158].…”

Section: A Role For N-cadherin In Myofibroblast-stimulated Invasionmentioning

confidence: 99%

Role of tissue stroma in cancer cell invasion

Wever

Mareel

2003

The Journal of Pathology

923

813

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“…PNI occurs in 2.5% to 14% of cases of cSCC, with most studies reporting rates < 5%. (32) Cutaneous SCCHN has a particularly high propensity for PNI, where it is an aggressive feature, portending an increased risk of locoregional recurrence and reduced disease-free survival. (33) In one series, 3-year disease-specific survival for cSCC with and without PNI was 64% and 91%, respectively.…”

Section: Epidemiology Of Perineural Growthmentioning

confidence: 99%

Molecular mechanisms of perineural spread of cutaneous carcinoma: a potential role for receptor tyrosine kinases and other biomarkers

Schmidt¹

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Perineural invasion and spread of cutaneous squamous cell carcinoma of the head and neck (cSCCHN) is associated with worse prognosis and high rates of locoregional recurrence. It occurs in less than 5% of cases, but given the high incidence of cSCC in Australia, portends significant morbidity and mortality. Primary tumour biology remains poorly understood and precise molecular mechanisms by which malignant squamous cells invade and progress axially within the perineural space remain unclear. Thus, there is no targeted therapy for perineural spread of cSCCHN or other neurotropic malignancies. Dysregulation of cell membrane receptor trafficking is a hallmark of cancer and such receptors are potential therapeutic targets.Over-expression of the epidermal growth factor receptor (EGFR) is well described in squamous cell carcinoma and the monoclonal antibody cetuximab is approved for advanced mucosal head Ultimately, we aim to improve survival and quality of life for sufferers of this morbid form of tumour spread. Our findings may also have implications for other neurotropic malignancy, including pancreatic, gastric, colorectal and prostate cancers. 4 Declaration by authorThis thesis is composed of my original work, and contains no material previously published or written by another person except where due reference has been made in the text. I have clearly stated the contribution by others to jointly-authored works that I have included in my thesis.

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Perineural Invasion of Cutaneous Malignancies

Abstract: Appropriate patient care mandates consideration of perineural invasion in the evaluation of cutaneous tumors. As the majority of patients present without symptoms of neural involvement, physicians must be vigilant in the search for this type of tumor spread.

Cited by 108 publications

References 132 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?

Role of tissue stroma in cancer cell invasion

Molecular mechanisms of perineural spread of cutaneous carcinoma: a potential role for receptor tyrosine kinases and other biomarkers

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