Dermatologic SurgeryCutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion
Section snippets
Methods
We conducted a prospective, noncomparative, multicenter, interventional case series of patients with cutaneous SCC treated with MMS in Australia and monitored by the SCFA between 1993 and 2002. All patients were treated by fellowship-trained MMS surgeons, using standard fresh-frozen MMS techniques, and the data were collected by the SCFA.
The criteria for selection were all cases of histologically diagnosed SCC with PNI treated with MMS. The following parameters were recorded: patient
Results
Data on PNI were available for 1177 patients who underwent MMS for cutaneous SCC (93.2%). PNI was diagnosed in 70 patients (5.95%); 54 were men (77.1%) and 16 were women (22.9%), with a mean age of 64 ± 15 years (median, 66 years; range, 35-96 years). There were 36 cases of PNI of the 772 cases of primary SCC (4.7%), and 34 cases of PNI of 491 cases with previously recurrent SCC (6.9%) (P = .04), comprising 51.4% and 48.6% of all PNI cases, respectively. Most tumors with PNI (91.4%) were present
Discussion
The perineural space is a cleavage plane between the nerve and the nerve sheath.10, 11 This plane extends from the small peripheral nerves, following their course to the subarachnoid space, and provides a pathway for cutaneous tumor spread to the central nervous system.12, 13 This mode of spread is a significant factor that contributes to the morbidity and mortality from cutaneous SCC.
In one of the first reports on PNI in skin tumors, Mohs and Lathrop5 reported 807 cases of SCC treated with
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Funding sources: None.
Conflicts of interest: None identified