title: Pain as an atypical presentation of squamous cell carcinoma.
abstract: BACKGROUND
  Cancer of the skin may be difficult to diagnose clinically if there are minimal skin findings on examination.
  
  
  OBJECTIVE
  To remind physicians that the symptoms of squamous cell carcinoma (SCC) may precede physical signs of the tumor.
  
  
  METHODS
  Perineural invasion of SCC was confirmed by histologic examination of surgical specimens.
  
  
  RESULTS
  We present two patients whose initial presentation of SCC was facial pain due to extensive perineural invasion. Their diagnoses were delayed until skin lesions eventually became evident months later.
  
  
  CONCLUSIONS
  Early detection can be lifesaving, thus emphasizing the importance of including skin cancer in the differential for facial pain or paresthesia.
authors.affiliation: Department of Dermatology, Baylor College of Medicine, Houston, Texas, USA.
authors.forename: T L
authors.initials: TL
authors.lastname: Schroeder
authors.forename: D F
authors.initials: DF
authors.lastname: Mac Farlane
authors.forename: L H
authors.initials: LH
authors.lastname: Goldberg
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000150:complications* / Q000175:diagnosis / Q000473:pathology; D005157:Facial Pain / Q000209:etiology*; D006801:Humans; D008297:Male; D009361:Neoplasm Invasiveness; D009915:Orbit / Q000294:innervation; D010525:Peripheral Nerves / Q000473:pathology; D012878:Skin Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000473:pathology