Walsh & Hoyt: Basal and Squamous Cell Carcinomas of the Skin

It is generally not appreciated that skin carcinomas may infiltrate deep connective tissue and neighboring sensory nerves. Basal and squamous cell carcinomas that affect the face may thus spread intracranially by infiltrating branches of the trigeminal nerve or facial nerve. Mohs and Lathrop reported that perineural spread occurred in 2.5% of 807 squamous cell carcinomas and in 1% of 1,686 basal cell carcinomas. Patients in whom such spread occurs often present with severe, continuous facial pain that they may describe as burning or stabbing. Because the primary tumor may have been a small lesion thought to have been totally removed months or years earlier, the patient may not relate a history of having had such a tumor to the physician who may initially diagnose ""atypical"" trigeminal neuralgia.