title: Epidemiology of clinical perineural invasion in cutaneous squamous cell carcinoma of the head and neck.
abstract: BACKGROUND
  Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (CSCCHN) is associated with decreased survival. Large-nerve PNI presents with clinical signs and symptoms and/or magnetic resonance imaging evidence of cranial nerve involvement. We sought to determine which variables predict a worse outcome and to analyze patterns of failure.
  
  
  METHODS
  Case series with planned data collection.
  
  
  METHODS
  Tertiary care center.
  
  
  METHODS
  Patients with large-nerve PNI from CSCCHN between 1996 and 2006 were identified from a prospectively collected database. Clinical and demographic variables were recorded. Local control rates and survival analysis were performed using Kaplan-Meier curves.
  
  
  RESULTS
  Thirty-six patients were identified (28 men and 8 women). The mean age was 61 years. Twenty-nine were treated with curative intent, and 7 received palliation. The mean follow-up was 35 months. Involvement of V3, disease zone, and the type of therapy were significantly associated with overall survival (P < .05). The 5-year disease-free survival for patients by therapy was 50% for subcranial surgeries, 53.6% for skull base surgery, and 0% for radiation and palliative therapies (P < .001). None of the patients treated with a skull base resection had a central recurrence, while all patients who received palliation had a central failure.
  
  
  CONCLUSIONS
  Disease extent, type of therapy, and involvement of V3 are all significant predictors of survival in PNI from CSCCHN. We confirmed that the natural history of the disease is central progression and that this can be halted, if detected early enough, by a properly planned skull base resection.
authors.affiliation: Medical College of Georgia, Augusta, Georgia, USA.
authors.forename: C Arturo
authors.initials: CA
authors.lastname: Solares
authors.forename: Ken
authors.initials: K
authors.lastname: Lee
authors.forename: Priya
authors.initials: P
authors.lastname: Parmar
authors.forename: Peter
authors.initials: P
authors.lastname: O'Rourke
authors.forename: Benedict
authors.initials: B
authors.lastname: Panizza
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D003391:Cranial Nerves / Q000473:pathology*; D018450:Disease Progression; D005260:Female; D006258:Head and Neck Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology*; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000453:epidemiology* / Q000473:pathology* / Q000628:therapy; D019291:Skull Base / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis