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Radiation Therapy for Skin Cancer pp 215–223Cite as

Squamous and Basal Cell Carcinomas with Perineural Invasion

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Abstract

Perineural invasion (PNI) occurs in 2–6 % of cutaneous head and neck basal and squamous cell carcinomas. It is associated with mid-face location, recurrent tumors, high histologic grade, and increasing tumor size. Although PNI may be associated with skin cancers arising in any location, it is a particular problem for those arising in the head and neck because of the proximity of cranial nerves and the increased difficulty obtaining wide margins. Patients may be asymptomatic with PNI appreciated on histopathologic examination (incidental) or may present with cranial nerve (CN) deficits (clinical); usually CNs V and VII. Magnetic resonance imaging may be obtained to detect and define the extent of PNI; computed tomography (CT) may assist with detecting or excluding regional lymph node metastases. Patients with apparently resectable cancers undergo surgery, often followed by postoperative radiotherapy (RT). Patients with unresectable cancers are treated with definitive RT. The 5-year outcomes after treatment for incidental vs. clinical PNI are: local control, 80 % and 55 %; cause-specific survival, 75 % and 65 %; and overall survival, 55 % and 50 %, respectively. The incidence of grade ≥3 complications is higher after treatment for clinical PNI vs. microscopic (incidental) PNI; approximately 35 % compared with 15 %, respectively. Proton beam RT may be used to reduce the risk of late complications by reducing RT dose to the visual apparatus and central nervous system.

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Authors and Affiliations

  1. Department of Radiation Oncology, College of Medicine, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32610, USA

    William M. Mendenhall

  2. Department of Radiology, University of Florida, 2000 SW Archer Road, Gainesville, FL, 32608, USA

    Jeffrey Bennett

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  1. William M. Mendenhall
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Correspondence to William M. Mendenhall .

Editor information

Editors and Affiliations

  1. Florida State University College of Medi, Division of Dermatology, Dermatology Associates of Tallahassee, Riggins Road 1707, Tallahassee, 32308, Florida, USA

    Armand B. Cognetta Jr.

  2. College of Medicine, Department of Radiation Oncology, University of Florida, 2000 SW Archer Road, Gainesville, 32610, Florida, USA

    William M. Mendenhall

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Mendenhall, W.M., Bennett, J. (2013). Squamous and Basal Cell Carcinomas with Perineural Invasion. In: Cognetta Jr., A., Mendenhall, W. (eds) Radiation Therapy for Skin Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4614-6986-5_18

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  • DOI: https://doi.org/10.1007/978-1-4614-6986-5_18

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  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4614-6985-8

  • Online ISBN: 978-1-4614-6986-5

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