A Case of Perineural Invasion from Squamous Cell Carcinoma (.pdf)

Squamous cell carcinoma (SCC) is the second most common cutaneous malignancy, accounting for 5% to 10% of periocular cutaneous tumors. Literature on SCC with perineural invasion (PNI) is scarce. Incidence ranges from 2.6 to 43.4%.Typical features for SCC with PNI are older patients, with recurrent and/or multiple incompletely excised SCC.Two groups of patients with PNI have been described: one without neurological symptoms (incidental finding on histological examination) and a second group with clinical symptoms of damaged nerves, which has an increased risk of local recurrence and regional and distant metastases. MRI provides the most sensitive radiographic methodology to detect PNI.Management guidelines for PNI are evolving. Radiotherapy for the potential proximal and distal extent of involvement is the mainstay of treatment. Combined chemoradiotherapy has shown improved outcome in bulky disease. Role of surgery is mostly diagnostic (biopsy) and palliative (7).