PERINEURAL SPREAD OF CUTANEOUS SQUAMOUS-CELL CARCINOMA VIA THE ORBIT - CLINICAL-FEATURES AND OUTCOME IN 21 CASES

Objective: To describe the clinical features, treatment, and outcome o f a series of patients with perineural spread (PNS) of cutaneous squam ous cell carcinoma (SCC) via the orbit. Design: A cohort study. Partic ipants: Twenty-one patients identified with PNS of cutaneous SCC via t he orbit. Intervention: Patients were treated with various combination s of conservative or radical surgery, external beam radiation therapy, and chemotherapy. Results: Of 21 cases, 17 (81%) were male, Age at pr esentation with PNS ranged from 38 to 82 years (median, 66 years). The forehead and eyebrow were the most common site of the primary lesion, All but one had altered or decreased sensation, but only nine present ed with pain, Fourteen (67%) had ophthalmoplegia at presentation, and 14 (67%) had evidence of PNS involving branches of the facial nerve. D espite combinations of radical surgery, conservative surgery, and radi ation therapy, no method of treatment appeared more effective, and 14 patients died from 9 months to 5 years after presentation with PNS (me dian, 3 years), usually from local and intracranial disease. Two survi ved to 14 and 18 years, one is alive at 3 years with recurrent local a nd distant disease, and four are alive without evidence of disease at 2, 3, 4, and 12 months after radiation therapy. Conclusions: Perineura l spread of cutaneous SCC via the orbit carries a poor prognosis, Earl y radiation therapy may offer the best form of palliation. The role of radical surgery probably is limited once orbital involvement is appar ent, as the cavernous sinus and facial nerve branches usually are invo lved.