Early Squamous Cell Carcinoma With Perineural Invasion: A Prospective Study Examining Anatomic Site, Tumor Surface Diameter, Invasion Depth, and Grade of Differentiation in 1,772 Consecutive Cases
Keywords:
squamous cell carcinoma, perineurial invasion, grade of differentiation, invasion depth, anatomic siteAbstract
Background: Squamous cell carcinoma (SCC) may present with perineural invasion (PNI).
Objective: To investigate the characteristics of early invasive SCC with or without PNI.
Methods: Consecutive SCC excisions were prospectively reviewed from a single Australian community-based practice for 2016-2018. Tumor characteristics recorded were anatomic site, maximum microscopic tumor surface diameter, invasion depth, grade of differentiation, and diameter of nerves with PNI.
Results: In total, 1,772 cases were collected. No PNI cases were found on female patients. Seven of the total 10 PNI cases were on facial sites. Maximum average microscopic tumor surface diameters ranged from 10.1 mm (well differentiated) up to 11.0 mm (moderately differentiated). Maximum average invasion depths by differentiation ranged from 1.7 (well differentiated) up to 2.6 mm (poorly differentiated). The PNI cases were as follows: well differentiated (n = 0), moderately differentiated (n = 4), or poorly differentiated (n = 6). Minimum average histopathological margins for well, moderately, and poorly differentiated SCC, respectively, were 1.4, 1.1, and 1.3 mm. Minimum microscopic tumor surface diameters for PNI cases were 7 mm for moderately and 5 mm for poorly differentiated SCC. Minimum microscopic invasion depths for PNI cases were 2.2 mm for moderate and 0.9 mm for poor differentiation.
Conclusions: We found early SCC with PNI displayed nerve diameters of 0.1 mm or less and were exclusively on male patients aged 60 or older, on chronically sun-exposed sites of the head and upper midline anterior chest. Histopathological features associated with PNI were moderate and poor differentiation, tumor invasion beyond 0.9 mm, and adjacent lymphocytosis.
References
Green AC, Olsen CM. Cutaneous squamous cell carcinoma: an epidemiological review. Br J Dermatol. 2017;177(2):373-381. https://doi.org/10.1111/bjd.15324
Thompson AK, Kelley BF, Prokop LJ, Murad MH, Baum CL. Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease specific death: a systematic review and meta-analysis. JAMA Dermatol. 2016;152(4): 419-428. https://doi.org/10.1001/jamadermatol.2015.4994
Leibovitch I, Huilgol SC, Selva D, Hill D, Richards S, Paver R. Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia I. Experience over 10 years. J Am Acad Dermatol. 2005;53(2):253-260. https://doi.org/10.1016/j.jaad.2005.02.059
Mendenhall WM, Amdur RJ, Williams LS, et al. Carcinoma of the skin of the head and neck with perineural invasion. Head Neck. 2002;24(1):78-83. https://doi.org/10.1002/hed.10025
Karia PS, Morgan FC, Ruiz ES, Schmults CD. Clinical and incidental perineural invasion of cutaneous squamous cell carcinoma: a systematic review and pooled analysis of outcomes data. JAMA Dermatol. 2017;153(8):781-788. https://doi.org/10.1001/jamadermatol.2017.1680
Lallas A, Pyne J, Kyrgidis A, et al. The clinical and dermoscopic features of invasive squamous cell carcinoma depend on the grade of differentiation. Br J Dermatol. 2015;172(5):1308-1315. https://doi.org/10.1111/bjd.13510
Okholm C, Frendø M, Kiss K, von Buchwald C. Cheek numbness caused by perineural tumor invasion of the infraorbital nerve: a review of 3 diagnostically challenging cases. Am J Case Rep. 2018;19:296-300. https://doi.org/10.12659/AJCR.907034
Pyne JH, Myint E, Clark SP, et al. Squamous cell carcinoma: pain as a clue to increased tumour diameter, increased invasion depth, the grade of differentiation, acantholysis and perineural invasion. J Clin Exp Dermatol. 2020;45(2):180-186. https://doi.org/10.1111/ced.14066
Verburg M, Lang M, Mühlstädt M, et al. Cutaneous squamous cell carcinoma with perineural invasion: report on eight cases and review of the literature. Dermatology. 2015;230(2):135-142. https://doi.org/10.1159/000368771
Campoli M, Brodland DG, Zitelli J. A prospective evaluation of the clinical, histologic, and therapeutic variables associated with incidental perineural invasion in cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2014;70(4):630-636. https://doi.org/10.1016/j.jaad.2013.11.034
Salmon PJ, Hussain W, Geisse JK, Grekin RC, Mortimer NJ. Sclerosing squamous cell carcinoma of the skin, an underemphasized locally aggressive variant: a 20-year experience. Dermatol Surg. 2011;37(5):664-670. https://doi.org/10.1111/j.1524-4725.2010.01850.x
Tang JC, Kim SL, Stratman EJ. Measuring the depth of perineural invasion in cutaneous squamous cell carcinoma: implications for biopsy technique. Dermatol Surg. 2018;44(9):1170-1173. https://doi.org/10.1097/DSS.0000000000001581
Lee AK, Yoo JY, Glusac EJ, Christensen SR. Cutaneous squamous cell carcinoma with subtle perineural invasion detected with cytokeratin and epithelial membrane antigen immunohistochemistry. JAAD Case Rep. 2018;4(9):934-937. https://doi.org/10.1016/j.jdcr.2018.09.002
Dunn M, Morgan MB, Beer TW. Perineural invasion: identification, significance, and a standardized definition. Dermatol Surg. 2009;35(2):214-221. https://doi.org/10.1111/j.1524-4725.2008.34412.x
Pyne JH, Myint E, Barr E, Clark SP, Na R. Invasive squamous cell carcinoma: a comparison of the grade of differentiation and tumour depth by anatomic site in 1666 cases. J Clin Exp Dermatol. 2018;43(1):3-10. https://doi.org/10.1111/ced.13222
Broders AC. Practical points on the microscopic grading of carcinoma. N Y State J Med. 1932;32:667-671.
Carter JB, Johnson MM, Chua TL, Karia PS, Schmults CD. Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11-year cohort study. JAMA Dermatol. 2013;149(1):35-41. https://doi.org/10.1001/jamadermatol.2013.746
Brantsch KD, Meisner C, Schönfisch B, et al. Analysis of risk factors in determining prognosis of cutaneous squamous cell carcinoma: a prospective study. Lancet Oncol. 2008;9(8):713-720. https://doi.org/10.1016/S1470-2045(08)70178-5
Published
Issue
Section
License
Dermatology Practical & Conceptual applies a Creative Commons Attribution License (CCAL) to all works we publish (http://creativecommons.org/licenses/by-nc/4.0/). Authors retain the copyright for their published work.
How to Cite
Share
