Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion Using Mohs Micrographic Surgery

Reule, Ross; Golda, Nicholas; Wheeland, Ronald G.

doi:10.1111/j.1524-4725.2009.01276.x

Cited by 20 publications

(18 citation statements)

References 46 publications

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“…A limitation may be skip lesions. Skip lesions are (1) processing artefacts, (2) inflammation with tumor regression or (3) a true skipping of regions of nerves as single tumor cells travel along the length of a nerve, making false-negative histological examination possible [3]. Recent investigations confirm former data that skip lesions in fact do not really exist [21].…”

Section: Discussionsupporting

confidence: 65%

“…Regarding the prognosis it is important to differentiate between these two groups. Patients with cPNI have a higher rate of recurrence and metastases compared to patients with aPNI [3,7]. Unfortunately, these two populations are often combined and not clearly distinguished in most publications.…”

Section: Discussionmentioning

confidence: 99%

“…Most patients treated with adjuvant RT had SCC with cPNI. The efficacy of surgical excision combined with adjuvant RT was seen to be 38-87% [3]. Whether adjuvant RT could also be beneficial in patients with SCC with aPNI is not known.…”

Section: Discussionmentioning

confidence: 99%

“…MMS is thought to be superior to standard surgical excision because there is a greater sensitivity to detect PNI and a lower rate of recurrence [24]. Local control rates for SCC with PNI achieved by MMS versus standard excision, with or without postoperative RT, ranged from 92 to 100% for MMS and from 38 to 87% for standard excision [3]. Cause-specific survival rates varied from 100 to 64% (table 2).…”

Section: Discussionmentioning

confidence: 99%

“…However, it does occur. Indicators of poor prognosis for local recurrences and metastatic disease in SCC are tumors >2 cm in diameter, tumor thickness ≥2 mm, poorly differentiated tumors, invasion into or below the reticular dermis, areas of previous irradiation, immunosuppression and - more recently acknowledged - perineural invasion (PNI) [3,4,5]. PNI was first described a century ago as the spread of tumor cells along the nerves just beneath the perineurium [6].…”

Section: Introductionmentioning

confidence: 99%

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Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Verburg¹,

Lang²,

Mühlstädt

et al. 2014

Dermatology

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Background: Perineural invasion (PNI) in cutaneous squamous cell carcinoma (SCC) is considered to be a negative prognostic factor. A lot of uncertainty remains regarding the classification, diagnosis, treatment and prognosis of SCC with PNI. Objective: To describe typical courses of SCC with PNI and associated findings in order to suggest an optimized diagnostic and therapeutic approach. Methods: We present eight cases of SCC with PNI, considering patient and tumor characteristics, histology, treatment and clinical course regarding local recurrence and metastasization. Results: SCC patients with PNI have a higher rate of local recurrences and greater risk for metastasization than SCC patients without PNI. Age ranged from 68 to 77 years, 6 patients were male and 2 female, with all tumors localized on the head. Three patients had chronic lymphocytic leukemia. Conclusion: Based on the data of this series and the current literature, we make suggestions for better diagnostic and therapeutic management.

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Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Verburg¹,

Lang²,

Mühlstädt

et al. 2014

Dermatology

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Defining, Treating, and Studying Very High-Risk Cutaneous Squamous Cell Carcinomas

Miller¹

2010

Arch Dermatol

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Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

et al. 2017

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IMPORTANCE Perineural invasion (PNI) in cutaneous squamous cell carcinoma (CSCC) has been associated with an increased risk of poor outcomes. Patients with PNI may present with clinical symptoms and/or radiologic evidence of PNI (clinical PNI [CPNI]), yet most patients are asymptomatic and PNI is often found on histologic examination (incidental PNI [IPNI]). Evidence-based estimates of the risks of disease-related outcomes comparing IPNI and CPNI are limited in the dermatology literature.OBJECTIVES To review and synthesize outcomes data for patients with CSCC and CPNI or IPNI.DATA SOURCES A systematic review was conducted in MEDLINE and EMBASE for English-language articles published since inception to November 11, 2016.STUDY SELECTION All studies that reported a disease-related outcome (local recurrence, nodal metastasis, distant metastasis, or disease-specific death) of CSCCs with CPNI and IPNI were included.DATA EXTRACTION AND SYNTHESIS Articles were screened for eligibility, and any possible discrepancies in this screening were resolved. Data extracted included study characteristics, tumor characteristics, treatments performed, and disease-related outcomes. Overall risks of disease-related outcomes were generated by pooling patients from eligible studies. χ 2 Statistics and Fisher exact tests were used to evaluate differences in disease-related outcomes.MAIN OUTCOMES AND MEASURES Risks of disease-related outcomes and 5-year recurrence-free, disease-specific, and overall survival. RESULTS A total of 12 studies containing 241 patients with CPNI and 381 patients with IPNI were included in the systematic review and analysis. The overall risks of local recurrence and disease-specific death were significantly higher in patients with CSCC and CPNI compared with those with CSCC and IPNI (local recurrence, 37% vs 17%; P < .001; disease-specific death, 27% vs 6%; P < .001). The risks of nodal metastasis and distant metastasis did not differ significantly by PNI classification. Patients with CSCC and CPNI had poorer mean 5-year recurrence-free survival and disease-specific survival compared with patients with IPNI (recurrence-free survival, 61% vs 76%; P = .009; disease-specific survival, 70% vs 88%; P = .002). CONCLUSIONS AND RELEVANCEPatients with CSCC and CPNI are at an increased risk of local recurrence and disease-specific death compared with patients with CSCC and IPNI and have a 30% risk of death. Patients with PNI may benefit from increased long-term surveillance. Further studies are needed to establish standardized guidelines on follow-up and dermatologic surveillance in this high-risk patient population.

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Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion Using Mohs Micrographic Surgery

Cited by 20 publications

References 46 publications

Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Cutaneous Squamous Cell Carcinoma with Perineural Invasion: Report on Eight Cases and Review of the Literature

Defining, Treating, and Studying Very High-Risk Cutaneous Squamous Cell Carcinomas

Clinical and Incidental Perineural Invasion of Cutaneous Squamous Cell Carcinoma

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