title: Perineural infiltration of cutaneous squamous cell carcinoma and basal cell carcinoma without clinical features.
abstract: OBJECTIVE
  To review the factors that influence outcome and patterns of relapse in patients with cutaneous squamous cell carcinoma (SCC) and basal cell carcinoma (BCC) with perineural infiltration (PNI) without clinical or radiologic features, treated with surgery and radiotherapy.
  
  
  METHODS
  Between 1991 and 2004, 222 patients with SCC or BCC with PNI on pathologic examination but without clinical or radiologic PNI features were identified. Charts were reviewed retrospectively and relevant data collected. All patients were treated with curative intent; all had radiotherapy, and most had surgery. The primary endpoint was 5-year relapse-free survival from the time of diagnosis.
  
  
  RESULTS
  Patients with SCC did significantly worse than those with BCC (5-year relapse-free survival, 78% vs. 91%; p < 0.01). Squamous cell carcinoma with PNI at recurrence did significantly worse than de novo in terms of 5-year local failure (40% vs. 19%; p < 0.01) and regional relapse (29% vs. 5%; p < 0.01). Depth of invasion was also a significant factor. Of the PNI-specific factors for SCC, focal PNI did significantly better than more-extensive PNI, but involved nerve diameter or presence of PNI at the periphery of the tumor were not significant factors.
  
  
  CONCLUSIONS
  Radiotherapy in conjunction with surgery offers an acceptable outcome for cutaneous SCC and BCC with PNI. This study suggests that focal PNI is not an adverse feature.
authors.affiliation: Cancer Care Services, Royal Brisbane and Women's Hospital, Brisbane, Queensland, Australia. Charles_Lin@health.qld.gov.au
authors.forename: Charles
authors.initials: C
authors.lastname: Lin
authors.forename: Lee
authors.initials: L
authors.lastname: Tripcony
authors.forename: Jacqui
authors.initials: J
authors.lastname: Keller
authors.forename: Michael
authors.initials: M
authors.lastname: Poulsen
authors.forename: Jarad
authors.initials: J
authors.lastname: Martin
authors.forename: James
authors.initials: J
authors.lastname: Jackson
authors.forename: Graeme
authors.initials: G
authors.lastname: Dickie
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002280:Basal Cell Carcinoma / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D002294:Carcinoma, Squamous Cell / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009364:Neoplasm Recurrence, Local / Q000473:pathology; D010525:Peripheral Nerves / Q000473:pathology*; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology*; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000532:radiotherapy / Q000601:surgery