title: Histopathological features of clinical perineural invasion of cutaneous squamous cell carcinoma of the head and neck and the potential implications for treatment.
abstract: BACKGROUND
  Nonmelanoma skin cancer (NMSC) with perineural invasion (PNI) is most commonly seen in cutaneous squamous cell carcinoma of the head and neck (SCCHN). The cranial nerves are a conduit for skin cancer to reach the brainstem.
  
  
  METHODS
  The histopathological features of 51 tissue specimens from 49 patients with cutaneous SCCHN and clinical PNI were assessed with consecutive transverse and longitudinal sections.
  
  
  RESULTS
  No skip lesions were identified. Tumor spread was contiguous in all specimens. No tumor spread into the perineural space from surrounding or adjacent tumor was seen. Proximal large cranial nerves showed epineural involvement in 3.9% in areas with large tumor bulk, extensive PNI, and intraneural invasion.
  
  
  CONCLUSIONS
  Perineural tumor spread in cutaneous SCCHN was contiguous and no skip lesions were evident in nerve specimens assessed in this series. Spread beyond cranial nerve perineurium was uncommon, reflecting its multilayer barrier function at this level. These findings may have treatment implications.
authors.affiliation: Department of Otolaryngology, Head and Neck Surgery and Queensland Skull Base Unit, Princess Alexandra Hospital, Brisbane, Queensland, Australia; School of Medicine, University of Queensland, Brisbane, Queensland, Australia.
authors.forename: Benedict
authors.initials: B
authors.lastname: Panizza
authors.forename: Timothy A
authors.initials: TA
authors.lastname: Warren
authors.forename: C Arturo
authors.initials: CA
authors.lastname: Solares
authors.forename: Glen M
authors.initials: GM
authors.lastname: Boyle
authors.forename: Duncan
authors.initials: D
authors.lastname: Lambie
authors.forename: Ian
authors.initials: I
authors.lastname: Brown
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000556:secondary* / Q000601:surgery; D015331:Cohort Studies; D003391:Cranial Nerves / Q000473:pathology; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology* / Q000556:secondary / Q000601:surgery; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010525:Peripheral Nerves / Q000473:pathology*; D010524:Peripheral Nervous System Neoplasms / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology* / Q000601:surgery; D000077195:Squamous Cell Carcinoma of Head and Neck; D016610:Tissue Embedding
keywords: head and neck neoplasms; perineurium; peripheral nerve neoplastic infiltration; skin cancer; squamous cell carcinoma