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.