Perineural spread of cutaneous squamous and basal cell carcinoma: CT and MR detection and its impact on patient management and prognosis

Purpose: To analyze the pretreatment imaging findings and outcome of patien ts with perineural spread of squamous or basal cell carcinoma of the face a nd scalp treated with radiotherapy, to determine whether CT (computed tomog raphy) or MR (magnetic resonance) imaging can be effectively used to identi fy patients who would benefit from aggressive treatment, and to characteriz e the imaging features associated with cure, Methods: Thirty-five patients had perineural spread of squamous and basal c ell carcinoma along the divisions of the trigeminal and/or facial nerves ba sed on clinical findings and/or histopathological proof, Perineural extensi on seen on imaging was divided into three zones of involvement. The volume of perineural disease was graded semiquanitatively, All patients received r adiotherapy with curative intent. Results: Eighteen of the 35 patients had imaging evidence of perineural spr ead of tumor, and the remaining 17 were imaging negative for perineural spr ead. The absolute fi-year survival of the imaging positive group was 50% co mpared with 86% in the imaging-negative group (p = 0.048), Conclusions: Imaging can be used to identify patients with advanced perineu ral spread who warrant aggressive radiotherapy. Imaging evidence of perineu ral invasion worsens prognosis; however, low-volume and peripheral perineur al disease is radiocurable, Greater perineural tumor volume with more centr al disease was associated with an unfavorable outcome, (C) 2001 Elsevier Sc ience Inc.