title: En Bloc Resection of Desmoplastic Neurotropic Melanoma with Perineural Invasion of the Intracranial Trigeminal and Intraparotid Facial Nerve: Case Report and Review of the Literature.
abstract: Background Desmoplastic neurotropic melanoma (DNM) is a rare, highly malignant, and locally invasive form of cutaneous melanoma with a tendency for perineural invasion (PNI). Methods We report a case of a 61-year-old man presenting with right-sided trigeminal neuralgia and progressive facial paresis due to the PNI of the intracranial trigeminal nerve and the intraparotid facial nerve from DNM. We also present a review of the literature with six cases of DNM with PNI of the intracranial trigeminal nerve identified. Results The combined transtemporal-infratemporal fossa approach was performed to achieve total en bloc resection of the tumor mass followed by postoperative radiotherapy (PORT). After 24 months of follow-up, the patient remains disease free with no signs of recurrence on magnetic resonance imaging. Conclusion We recommend the en bloc resection of the tumor mass followed by PORT for the management of DNM with PNI. A high index of suspicion for PNI as a cause of cranial neuropathies is essential for the early detection and treatment of patients with known melanoma.
authors.affiliation: Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
authors.forename: Serkan
authors.initials: S
authors.lastname: Erkan
authors.affiliation: Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia.
authors.forename: Aanand N
authors.initials: AN
authors.lastname: Acharya
authors.affiliation: Department of Plastics Surgery, Royal Perth Hospital, Perth, Western Australia, Australia.
authors.forename: James
authors.initials: J
authors.lastname: Savundra
authors.affiliation: Perth Neurosurgery, Hollywood Medical Centre, Nedlands, Western Australia, Australia.
authors.forename: Stephen B
authors.initials: SB
authors.lastname: Lewis
authors.affiliation: Department of Otolaryngology, Head and Surgery, Fiona Stanley Hospital, Murdoch, Western Australia, Australia; Skull Base Division, Otolaryngology, Head and Neck Surgery, University of Western Australia, Murdoch, Western Australia, Australia.
authors.forename: Gunesh P
authors.initials: GP
authors.lastname: Rajan
keywords: desmoplastic neurotropic melanoma; facial palsy; perineural invasion; skull base; trigeminal neuralgia