Perineural Invasion in Head and Neck Cutaneous Squamous Cell Carcinoma

Abstract

Background/Objectives: Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer, with a lifetime risk of 14-20% that is rising every year. Although prognosis for cSCC is generally good, certain high-risk features of cSCC portend increased rates of nodal and distant metastasis, recurrence, and disease-specific mortality. One such high-risk factor is perineural invasion (PNI), which is broadly defined as the invasion of cancer into and around nerves. Compared to other high-risk factors, PNI presence is associated with the highest risk for locoregional and distant metastasis. Still, the mechanisms underlying the pathogenesis of PNI remain poorly understood. Recent studies suggest the migration and invasion of tumors into nerves is a result of complex molecular crosstalk within the tumor-nerve microenvironment, wherein the milieu of signaling molecules simultaneously promote neuronal growth and tumor cell invasion. Methods: Understanding the molecular and cellular mechanisms that promote PNI will lead to future developments of targeted therapies that may improve locoregional control and survival. Results/Conclusions: In our article, we aim to provide a comprehensive review of recent findings about the pathogenesis of PNI, clinical implications of PNI-positive disease in cSCC, available treatment modalities, and potential future therapeutic targets.

Keywords: cutaneous squamous cell carcinoma; head; neck; perineural invasion; skin cancer.

Figure 1

Generalized Diagram of the Tumor-Nerve Microenvironment and the Pathogenesis of PNI. Cancer, nerve, and support cells secrete signaling molecules to enhance oncogenesis and neuritogenesis. These mechanisms are thought to be the primary drivers of the development of PNI.

Figure 2

Simplified Algorithm for Treatment of High Risk cSCC. PNI: perineural invasion; cSCC: cutaneous squamous cell carcinoma; WLE: wide local excision; MMS: Mohs micrographic surgery.