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Updated: Aug 16, 2026
A Model for Perineural Invasion in Head and Neck Squamous Cell Carcinoma
Published on: January 5, 2017
Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion
Igal Leibovitch1, Shyamala C Huilgol, Dinesh Selva
1Oculoplastic and Orbital Division, Department of Ophthalmology and Visual Sciences, Royal Adelaide Hospital, University of Adelaide, Adelaide, South Australia.
Background:
Perineural invasion (PNI) is an important factor may possibly influence the aggressiveness of basal cell carcinoma (BCC).
Objective:
Our purpose was to evaluate the incidence, features, and outcomes of BCC with PNI in patients treated with Mohs micrographic surgery (MMS).
Method:
This prospective, multicenter case series included all patients in Australia treated with MMS for BCC with PNI, who were monitored by the Skin and Cancer Foundation Australia between 1993 and 2002. The parameters recorded were patient demographics, reason for referral, duration of tumor, site, preoperative tumor size, recurrence before MMS, histologic subtypes, postoperative defect size, and recurrence at 5 years after MMS.
Results:
Two-hundred eighty-three patients were diagnosed with PNI. Most cases occurred in male patients (61%; P = .006) and in previously recurrent tumors (60.4%; P < .001). The infiltrating, morpheic, and basosquamous subtypes were more likely to be associated with PNI (P < .0001). Tumor sizes before excision and postoperative defect sizes were significantly larger in cases with PNI compared with cases with no PNI (P < .001 for both parameters), as was the mean number of Mohs excision levels. Seventy-eight patients completed a 5-year follow-up period after MMS, and 6 of them (7.7%) were diagnosed with recurrence.
Limitations:
Data were missing for some outcome measures.
Conclusion:
PNI is an uncommon feature of BCC. When present, PNI is associated with larger, more aggressive tumors, and the risk of 5-year recurrence is higher. This emphasizes the importance of tumor excision with margin control and long-term patient monitoring.
Insights
Perineural invasion (PNI) is uncommon in basal cell carcinoma (BCC), but when present, it indicates larger, more aggressive tumors. Patients with PNI have a higher risk of recurrence after Mohs micrographic surgery (MMS), necessitating careful monitoring.
Area of Science:
- Dermatology
- Oncology
- Surgical Pathology
Background:
- Perineural invasion (PNI) is a potential indicator of basal cell carcinoma (BCC) aggressiveness.
- Understanding PNI in BCC is crucial for predicting patient outcomes.
Purpose of the Study:
- To evaluate the incidence, characteristics, and outcomes of BCC with PNI.
- To assess the efficacy of Mohs micrographic surgery (MMS) in managing BCC with PNI.
Main Methods:
- A prospective, multicenter case series of BCC patients with PNI treated with MMS in Australia (1993-2002).
- Data collected included patient demographics, tumor characteristics, surgical details, and 5-year recurrence rates.
- Analysis compared outcomes of BCC with PNI versus those without PNI.
Main Results:
- PNI was diagnosed in 283 patients, predominantly males and in previously recurrent tumors.
- Infiltrating, morpheic, and basosquamous BCC subtypes were more frequently associated with PNI.
- BCC with PNI exhibited larger tumor and postoperative defect sizes, and required more Mohs excision levels.
- A 7.7% recurrence rate was observed at 5 years among the 78 patients with PNI who completed follow-up.
Conclusions:
- Perineural invasion is an uncommon but significant feature in BCC.
- PNI is linked to more aggressive tumor behavior, larger size, and increased recurrence risk.
- Effective tumor excision with margin control and sustained patient surveillance are vital for managing BCC with PNI.
