Perineural extension to the skull base from early cutaneous malignancies of the midface.

Objective: To document the clinical progression of four patients with a past history of complete removal of early midface cutaneous malignancies that presented years later with isolated recurrence along the distribution of the infraorbital nerve, and to discuss the diagnostic role of early imaging to identify perineural invasion.

Study Design: The study is a retrospective chart review, review of radiographic findings, and review of the literature.

Results: The authors report four cases of isolated perineural invasion along the infraorbital nerve resulting from previously excised cutaneous malignancies.

Conclusions: Pain followed by anesthesia in the distribution of second division of the trigeminal nerve should alert the practitioner about possible perineural recurrence that may require imaging and open exploration to establish the diagnosis.