Perineural spread of basosquamous carcinoma to the orbit, cavernous sinus, and infratemporal fossa

Abstract

Basosquamous carcinoma is a rare, highly aggressive variant of basal cell carcinoma with elevated rates of recurrence, perineural invasion, and metastasis. We describe a patient who presented with unilateral complete ophthalmoplegia, ptosis, optic neuropathy, and trigeminal neuropathy due to perineural intracranial invasion of nasal basosquamous carcinoma via the sphenopalatine fossa to the cavernous sinus, orbit, and infratemporal fossa. To our knowledge, this is the first reported case of basosquamous carcinoma with perineural invasion involving the cavernous sinus in the English language ophthalmic literature. Physicians should be aware of the diagnostic features, clinical challenges and aggressive nature of basosquamous carcinoma, a rare diagnosis that can lead to significant morbidity/mortality when left unrecognized.

Cells to Surgery Quiz: December 2019

“…In addition, a case report by Amram et al (2018) described a patient with BSC causing perineural invasion that led to metastases of the orbit, cavernous sinus, and infratemporal fossa. Furthermore, Martin et al (2000) discovered that male sex, positive surgical resection margins, lymphatic invasion, and perineural involvement were all significant predictors of BSC recurrence.…”