Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck

Benedict Panizza, Clementino Arturo Solares, Michael Redmond, Priya Parmar, Peter O'Rourke

Research output: Contribution to journalArticle

34 Citations (Scopus)

Abstract

Background. Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (SCCHN) is associated with decreased survival. Patients with large nerve or clinical PNI present with clinical signs and symptoms or MRI evidence of cranial nerve involvement. These patients often succumb to disease that spreads into the brainstem. In our experience, when the disease extends up to the Gasserian or Geniculate ganglion, surgical resection with negative margins provides the best chance for cure. Herein we review our experience to validate our clinical observations. Methods. We identified patients with large nerve PNI from cutaneous SCCHN between January 1996 and 2006 from a prospectively collected database. Patients who underwent surgical resection as their primary mode of therapy were included. Clinical and demographic variables were recorded. Survival analysis was performed with Kaplan-Meier curves, and the log-rank test was used for significance testing between groups. Results. Twenty-one patients were identified. The mean age was 60 (range, 38-86) years, with 15 men and 6 women. Nineteen patients had a formal skull base resection, whereas 2 patients had a subcranial resection. We had 3 complications in our series: extradural hemorrhage (n = 1), cerebrospinal fluid leak (n = 1), and wound infection (n = 1). None of the patients who underwent a formal skull base resection to include the lateral cavernous sinus (ie, Gasserian ganglion) suffered ocular palsies or permanent morbidity when the orbit was preserved (n = 11). We had no surgical deaths. The average length of stay was 9 days (SD 6.3 days). The 5-year disease specific survival rate for the entire group was 64.3%. V3 involvement resulted in lower, although not significant, 5-year disease-free survival rates- 0% for those patients with involvement (n = 4) versus 66.8% for no involvement of V3 (n = 17). Conclusion. Appropriately planned surgical resection of PNI in cutaneous SCCHN up to the ganglion as dictated by the disease extent may improve survival without significant added morbidity.

Original languageEnglish (US)
Pages (from-to)1622-1627
Number of pages6
JournalHead and Neck
Volume34
Issue number11
DOIs
StatePublished - Nov 1 2012

Fingerprint

Skin
Trigeminal Ganglion
Skull Base
Survival Rate
Geniculate Ganglion
Transverse Sinuses
Morbidity
Carcinoma, squamous cell of head and neck
Cavernous Sinus
Survival
Cranial Nerves
Orbit
Wound Infection
Survival Analysis
Ganglia
Paralysis
Brain Stem
Disease-Free Survival
Signs and Symptoms
Length of Stay

Keywords

  • basal cell carcinoma
  • cutaneous squamous cell carcinoma
  • neurotropism
  • perineural invasion
  • radiation therapy
  • skull base surgery

ASJC Scopus subject areas

  • Otorhinolaryngology

Cite this

Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck. / Panizza, Benedict; Solares, Clementino Arturo; Redmond, Michael; Parmar, Priya; O'Rourke, Peter.

In: Head and Neck, Vol. 34, No. 11, 01.11.2012, p. 1622-1627.

Research output: Contribution to journalArticle

Panizza, B, Solares, CA, Redmond, M, Parmar, P & O'Rourke, P 2012, 'Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck', Head and Neck, vol. 34, no. 11, pp. 1622-1627. https://doi.org/10.1002/hed.21986
Panizza, Benedict ; Solares, Clementino Arturo ; Redmond, Michael ; Parmar, Priya ; O'Rourke, Peter. / Surgical resection for clinical perineural invasion from cutaneous squamous cell carcinoma of the head and neck. In: Head and Neck. 2012 ; Vol. 34, No. 11. pp. 1622-1627.
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abstract = "Background. Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (SCCHN) is associated with decreased survival. Patients with large nerve or clinical PNI present with clinical signs and symptoms or MRI evidence of cranial nerve involvement. These patients often succumb to disease that spreads into the brainstem. In our experience, when the disease extends up to the Gasserian or Geniculate ganglion, surgical resection with negative margins provides the best chance for cure. Herein we review our experience to validate our clinical observations. Methods. We identified patients with large nerve PNI from cutaneous SCCHN between January 1996 and 2006 from a prospectively collected database. Patients who underwent surgical resection as their primary mode of therapy were included. Clinical and demographic variables were recorded. Survival analysis was performed with Kaplan-Meier curves, and the log-rank test was used for significance testing between groups. Results. Twenty-one patients were identified. The mean age was 60 (range, 38-86) years, with 15 men and 6 women. Nineteen patients had a formal skull base resection, whereas 2 patients had a subcranial resection. We had 3 complications in our series: extradural hemorrhage (n = 1), cerebrospinal fluid leak (n = 1), and wound infection (n = 1). None of the patients who underwent a formal skull base resection to include the lateral cavernous sinus (ie, Gasserian ganglion) suffered ocular palsies or permanent morbidity when the orbit was preserved (n = 11). We had no surgical deaths. The average length of stay was 9 days (SD 6.3 days). The 5-year disease specific survival rate for the entire group was 64.3{\%}. V3 involvement resulted in lower, although not significant, 5-year disease-free survival rates- 0{\%} for those patients with involvement (n = 4) versus 66.8{\%} for no involvement of V3 (n = 17). Conclusion. Appropriately planned surgical resection of PNI in cutaneous SCCHN up to the ganglion as dictated by the disease extent may improve survival without significant added morbidity.",
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AB - Background. Perineural invasion (PNI) in cutaneous squamous cell carcinoma of the head and neck (SCCHN) is associated with decreased survival. Patients with large nerve or clinical PNI present with clinical signs and symptoms or MRI evidence of cranial nerve involvement. These patients often succumb to disease that spreads into the brainstem. In our experience, when the disease extends up to the Gasserian or Geniculate ganglion, surgical resection with negative margins provides the best chance for cure. Herein we review our experience to validate our clinical observations. Methods. We identified patients with large nerve PNI from cutaneous SCCHN between January 1996 and 2006 from a prospectively collected database. Patients who underwent surgical resection as their primary mode of therapy were included. Clinical and demographic variables were recorded. Survival analysis was performed with Kaplan-Meier curves, and the log-rank test was used for significance testing between groups. Results. Twenty-one patients were identified. The mean age was 60 (range, 38-86) years, with 15 men and 6 women. Nineteen patients had a formal skull base resection, whereas 2 patients had a subcranial resection. We had 3 complications in our series: extradural hemorrhage (n = 1), cerebrospinal fluid leak (n = 1), and wound infection (n = 1). None of the patients who underwent a formal skull base resection to include the lateral cavernous sinus (ie, Gasserian ganglion) suffered ocular palsies or permanent morbidity when the orbit was preserved (n = 11). We had no surgical deaths. The average length of stay was 9 days (SD 6.3 days). The 5-year disease specific survival rate for the entire group was 64.3%. V3 involvement resulted in lower, although not significant, 5-year disease-free survival rates- 0% for those patients with involvement (n = 4) versus 66.8% for no involvement of V3 (n = 17). Conclusion. Appropriately planned surgical resection of PNI in cutaneous SCCHN up to the ganglion as dictated by the disease extent may improve survival without significant added morbidity.

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