Perineural Invasion of Cutaneous Malignancies

Abstract

background. Perineural invasion is an important mode of tumor spread and is associated with increased aggressiveness and a propensity for recurrence among cutaneous malignancies. objective. To review the pathogenesis, diagnosis, and treatment of cutaneous tumors exhibiting perineural invasion. methods. This article is based on a review of the medical literature concerning tumors with perineural involvement. results. This article describes the clinical signs and histologic features of cutaneous malignancies exhibiting perineural involvement. conclusion. 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.

The incidence and risk factors of metastasis for cutaneous squamous cell carcinoma-implications on the T-classification system

“…Furthermore, PNI has been shown to be an independent predictor of poorer 3‐year disease specific survival (64% vs. 91%; P = 0.002). On multi‐variate analysis, we report that PNI increases the risk of metastasis five‐fold (HR 5.29, 95% CI; 2.50–11.21, P < 0.0001) .…”

Predictors of Reconstruction with Mohs Removal of Nonmelanoma Skin Cancers

“…The “H zone” consists of the temporal region, periauricular region, periorbital region, nasal tip and ala, and the upper lip region. These regions are high‐risk locations for BCC because of their tendency to invade the dermis, periosteum, perichondrium, nerve sheaths, and blood vessels 1,11,15–17 . In addition, deep tumor spread is commonly found in the preauricular area, along the columella of the nose, and at the junction of the nasal ala with the nasolabial fold, areas hypothesized to coincide with embryonic fusion planes and thus less likely to resist tumor spread 15 .…”

Update of the European guidelines for basal cell carcinoma management

“…The tumour size is crucial and a BCC with a diameter less than 2 cm would need a minimum margin of 4 mm to totally eradicate the tumour in more than 95% of cases [52]. However, the margins are also different for the different types of BCC and also depend on whether the tumour is primary or recurrent or incompletely excised, and on the presence or absence of perineural invasion [53,54]. For example, a high-risk primary BCC of 2 cm would need a safety margin of at least 13 mm for relative certainty of removal of the tumour in 95% of cases [55].…”