title: Carcinoma of the skin of the head and neck with perineural invasion.
abstract: BACKGROUND
  Perineural invasion is observed in a small subset of patients with carcinomas of the skin of the head and neck.
  
  
  METHODS
  Review of the patient literature highlighting the University of Florida experience.
  
  
  RESULTS
  Patients with early perineural invasion are asymptomatic, and the phenomenon is discovered only on pathologic examination of the excised lesion. These patients are defined as having "incidental" perineural invasion, and treatment with surgery followed by postoperative irradiation results in a cure rate of approximately 80%. Undiagnosed, the perineural carcinoma slowly progresses and eventually results in symptoms, usually facial weakness or numbness. The disease eventually extends to the skull base and becomes incompletely resectable. Symptomatic patients are defined as having "clinical" perineural invasion, and aggressive treatment results in a cure rate of approximately 45%.
  
  
  CONCLUSIONS
  Perineural invasion is an uncommon spread pattern observed in patients with skin cancer and is associated with a relatively poor prognosis. The likelihood of cure is inversely related to the proximal extent of the cancer and is lower for symptomatic compared with asymptomatic patients.
authors.affiliation: Department of Radiation Oncology, University of Florida Health Science Center, PO Box 100385, Gainesville, FL 36210-0385, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Amdur
authors.forename: Lorna Sohn
authors.initials: LS
authors.lastname: Williams
authors.forename: Anthony A
authors.initials: AA
authors.lastname: Mancuso
authors.forename: Scott P
authors.initials: SP
authors.lastname: Stringer
authors.forename: Nancy
authors.initials: N
authors.lastname: Price Mendenhall
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology*; D003391:Cranial Nerves / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology / Q000473:pathology*; D006801:Humans; D015994:Incidence; D008279:Magnetic Resonance Imaging; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D016019:Survival Analysis; D014057:Tomography, X-Ray Computed