Perineural invasion in skin cancer of the head and neck: a review of nine cases.

PURPOSE: To review the management and outcome of skin cancer of the head and neck with perineural invasion, a relatively uncommon and complex condition, in nine patients treated between 1965 and 1991.

PATIENTS: Seven patients had skin cancers that were larger than 2 cm. All lesions were moderately or poorly differentiated. Curative surgery was performed in all nine cases, with or without radiotherapy.

RESULTS

Local recurrence or regional disease appeared in three individuals; surgical salvage produced satisfactory results. At last follow-up (median, 45 months; range, 18 to 201 months), no one had developed intracranial or skull base metastasis; lung cancer was detected in one patient. The crude survival rate was 33% at 5 years and 22% at 10 years. The median survival was 25 months in patients who presented with neurologic symptoms and was 49 months in asymptomatic persons.

CONCLUSION

Although the prognosis in patients with skin cancer of the head and neck complicated by perineural invasion is expectedly poor, long-term disease-free survival is attainable with the use of aggressive therapy.