Perineural spread leading to orbital invasion from skin cancer

Veness, Michael J.; Biankin, Sandra A.

doi:10.1046/j.1440-1673.2000.00817.x

Cited by 45 publications

(62 citation statements)

References 20 publications

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“…Current practice for postoperative radiotherapy includes irradiation of central disease, as previously described, but for the cutaneous distribution of the particular cranial nerve branch to the facial midline only. 8,11 Within our subset, patients 1, 3, 4, and 6 did not have evidence of a second primary on the contralateral hemiface that potentially could have been responsible for the clinical findings. Patients 1, 3, and 4 had primary lesions occur on the nose, close to the midline, whereas patient 6 had multiple recurrences at the midline margin of the radiotherapy volume.…”

Section: Discussionmentioning

confidence: 86%

“…7 The orbit can also be accessed through spread along the ophthalmic nerve (V1), and patients may present with diplopia and/or visual impairment. 8 Facial nerve involvement is characterized by a slowly progressive palsy of the affected hemiface. 7,9 The anatomic extent of PNS seen on MRI has a previously described zonal classification and allows for surgical planning.…”

Section: Discussionmentioning

confidence: 99%

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Cutaneous Head and Neck Malignancies With Perineural Spread to Contralateral Cranial Nerves: An Argument for Extending Postoperative Radiotherapy Volume

Barnett

Foote

Panizza

2013

JCO

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IntroductionThe incidence of nonmelanoma cutaneous head and neck malignancies is increasing worldwide.1 In a small percentage of cases, associated perineural spread (PNS) of cranial nerves occurs, resulting in poor prognosis, with a recorded 5-year survival rate of 50% to 64.3%. 2,3 Patients with clinical PNS from cutaneous head and neck malignancies are treated with surgical resection and postoperative radiotherapy. Recent literature provides few reports of PNS that extends across the facial midline to affect the contralateral cranial nerves. 4 This report describes patients with ipsilateral cranial nerve PNS that has subsequently progressed to contralateral cranial nerves, to both highlight and address the potential implications for the postoperative radiotherapy volume. Case ReportsWithin a cohort of 55 patients who were treated from 1996 to 2011 with confirmed PNS from a cutaneous malignancy, six patients with ipsilateral cranial nerve PNS and subsequent contralateral PNS were identified. Patient demographic and clinical characteristics were reviewed and are summarized in Table 1. Ethics approval was obtained from our institution's Human Research Ethics Committee.Case Example. A 49-year-old woman (Table 1, patient 4) presented with a 3-month history of increasing swelling and pain in the left cheek. Twelve years before, the patient had sustained a blast/burn injury to the left hemiface, and 18 months before presentation, had a squamous cell carcinoma (SCC) on the left side of the nose excised with adjuvant radiotherapy. A computed tomography scan indicated recurrence of the lesion, with bony erosion of the inferior orbit and anterior maxillary wall and extension into the antrum. A magnetic resonance imaging (MRI) scan showed involvement of V2 at the foramen rotundum to the anterior aspect of Meckel's cave. Surgery involved en bloc removal of the left cheek skin, lateral nose wall, orbit floor, periorbita, and the infraorbital nerve to the gasserian ganglion. Reconstruction was performed with radial artery forearm flap and split skin graft. Histopathology confirmed SCC with PNS of left V2 to the anterior aspect of Meckel's cave. The patient received postoperative radiotherapy to the operative bed, as previously described, back to the gasserian ganglion, using a total dose of 60 Gy in 30 fractions. The cutaneous branches of V2 (with some extension into V3 cutaneous distribution) were treated, but only the proximal part of V3. This was delivered by a mix of electrons and three-dimensional conformal photon radiotherapy. Five years after surgery, the patient developed paresthesia, formication, and pain in the right cheek. An MRI scan showed abnormal thickening and enhancement that were consistent with PNS along the intra-and extracranial segments of right V2 and V3. The patient refused additional treatment and died as a result of her contralateral disease 13 months after detection. DiscussionThe trigeminal (V) and facial (VII) nerves are the most common cranial nerves to be affected by PNS, 5 and disease may prog...

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Section: Discussionmentioning

confidence: 86%

Section: Discussionmentioning

confidence: 99%

Cutaneous Head and Neck Malignancies With Perineural Spread to Contralateral Cranial Nerves: An Argument for Extending Postoperative Radiotherapy Volume

Barnett

Foote

Panizza

2013

JCO

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“…To our knowledge there is little consensus among pathologists regarding a precise definition of PNI. 1 Some pathologists regard PNI as malignant cells surrounding a nerve, others state that the presence of malignant cells inside the epineurium is sufficient, and others require involvement of a nerve outside the main tumor bulk. 1 One investigator has proposed that the necessary and sufficient condition for PNI is the presence of unequivocal tumor cells inside the perineurium.…”

Section: Conclusion Previous Reportsmentioning

confidence: 99%

“…1 Some pathologists regard PNI as malignant cells surrounding a nerve, others state that the presence of malignant cells inside the epineurium is sufficient, and others require involvement of a nerve outside the main tumor bulk. 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).…”

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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“…The concept of "skip lesions" in PNI is controversial. One set of authors believe in the presence of so called skip lesions in PNI, although none of them provide a convincing evidence to prove the presence of this entity [5][6][7][8]. The other set of authors believe that the concept of skip lesions in PNI does not exist and is a misinterpretation which is being propagated in the medical literature by blind quoting of existing false information in the medical literature [9][10][11].…”

Section: Introductionmentioning

confidence: 99%