title: Cutaneous head and neck basal and squamous cell carcinomas with perineural invasion.
abstract: Perineural invasion (PNI) occurs in 2% to 6% of cutaneous head and neck basal and squamous cell carcinomas (SCCs) and is associated with mid-face location, recurrent tumors, high histologic grade, and increasing tumor size. Patients may be asymptomatic with PNI appreciated on pathologic examination of the surgical specimen (microscopic), or may present with cranial nerve (CN) deficits (clinical). The V and VII CNs are most commonly involved. Magnetic resonance imaging (MRI) may be obtained to detect and define the extent of PNI; computed tomography (CT) or ultrasound-guided fine needle aspiration cytology (UGFNAC) may assist with detecting or excluding regional lymph node metastases. Patients with apparently resectable cancers undergo surgery, usually followed by postoperative radiotherapy (RT). Patients with unresectable cancers are treated with definitive RT. Moreover, RT may be considered if significant functional or cosmetic impairment is expected after surgical treatment. The 5-year outcomes after treatment for clinically unsuspected microscopic compared with clinical PNI are: local control, 80% and 55%; cause-specific survival, 75% and 65%; and overall survival, 55% and 50%, respectively. The incidence of grade ≥ 3 complications is higher after treatment for clinical PNI versus microscopic PNI; approximately 35% compared with 15%, respectively. Proton beam RT may be used to reduce the risk of late complications by reducing RT dose to the visual apparatus and central nervous system (CNS).
authors.affiliation: Department of Radiation Oncology, University of Florida, Gainesville, FL, USA.
authors.forename: William M
authors.initials: WM
authors.lastname: Mendenhall
authors.affiliation: ENT Clinic, University of Udine, Udine, Italy. Electronic address: a.ferlito@uniud.it.
authors.forename: Alfio
authors.initials: A
authors.lastname: Ferlito
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands.
authors.forename: Robert P
authors.initials: RP
authors.lastname: Takes
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Carol R
authors.initials: CR
authors.lastname: Bradford
authors.affiliation: Division of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.
authors.forename: June
authors.initials: J
authors.lastname: Corry
authors.affiliation: Division of Otolaryngology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa.
authors.forename: Johannes J
authors.initials: JJ
authors.lastname: Fagan
authors.affiliation: ENT Clinic, University of Udine, Udine, Italy.
authors.forename: Alessandra
authors.initials: A
authors.lastname: Rinaldo
authors.affiliation: Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia.
authors.forename: Primož
authors.initials: P
authors.lastname: Strojan
authors.affiliation: Department of Otolaryngology, Hospital Universitario Central de Asturias, Oviedo, Spain; Instituto Universitario de Oncología del Principado de Asturias, Oviedo, Spain.
authors.forename: Juan P
authors.initials: JP
authors.lastname: Rodrigo
mesh_terms: D001932:Brain Neoplasms / Q000175:diagnosis / Q000628:therapy*; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000628:therapy*; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis / Q000628:therapy*; D061765:Endoscopic Ultrasound-Guided Fine Needle Aspiration; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000628:therapy*; D006801:Humans; D008207:Lymphatic Metastasis; D008279:Magnetic Resonance Imaging; D015580:Mohs Surgery; D010524:Peripheral Nervous System Neoplasms / Q000175:diagnosis / Q000628:therapy*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000628:therapy*; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome