title: Which features of advanced head and neck basal cell carcinoma are associated with perineural invasion?
abstract: BACKGROUND
  Perineural invasion is a unique route for tumor dissemination. In basal cell carcinomas, the incidence is low, but increases in advanced cases. Its importance is recognized but not fully understood.
  
  
  OBJECTIVE
  To compare head and neck basal cell carcinomas with and without perineural invasion.
  
  
  METHODS
  A retrospective medical chart review of multidisciplinary surgeries for basal cell carcinomas that required a head and neck surgery specialist in a tertiary referral center was performed. Clinical-demographics and histopathological features were analyzed.
  
  
  RESULTS
  Of 354 cases, perineural invasion was present in 23.1%. Larger tumors and morpheaform subtype were statistically related to perineural invasion. Nodular and superficial subtypes were less frequent in positive cases. No significant difference was found in gender, age, ulceration, location, and mixed histology.
  
  
  CONCLUSIONS
  In this series of selected patients with basal cell carcinomas submitted to major resections, perineural invasion was clearly related to morpheaform subtype and to larger tumors. Other classically associated features, such as location in high-risk mask zone of the face, male gender and mixed histology, were not so strongly linked to perineural invasion.
authors.affiliation: Universidade de São Paulo (USP), São Paulo, SP, Brazil. Electronic address: andre_bandiera@yahoo.com.br.
authors.forename: André Bandiera de Oliveira
authors.initials: AB
authors.lastname: Santos
authors.affiliation: Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Natália Martins Magacho de
authors.initials: NM
authors.lastname: Andrade
authors.affiliation: Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Lenine Garcia
authors.initials: LG
authors.lastname: Brandão
authors.affiliation: Universidade de São Paulo (USP), São Paulo, SP, Brazil.
authors.forename: Claudio Roberto
authors.initials: CR
authors.lastname: Cernea
mesh_terms: D002280:Basal Cell Carcinoma / Q000473:pathology*; D003390:Cranial Nerve Neoplasms / Q000473:pathology*; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000473:pathology*
keywords: Basal cell carcinoma; Cabeça e pescoço; Carcinoma basocelular; Head and neck; Invasão perineural; Perineural invasion