Mohs resection and postoperative radiotherapy for head and neck cancers with incidental perineural invasion

To update our experience treating cutaneous squamous cell carcinoma (SCC) and basal cell carcinomas (BCC) of the head and neck with incidental perineural invasion (PNI) using Mohs resection followed by radiotherapy (RT). We compare outcomes between head and neck patients with incidental PNI who received Mohs surgery and those who did not.

From 1987 to 2009, 36 patients were treated with Mohs resection followed by postoperative RT; 82 patients were treated with resection other than Mohs followed by postoperative RT.

The 5-year overall survival and cause-specific survival rates for patients who received Mohs resection plus RT and those who received a non-Mohs resection plus RT were 53% versus 56% (p=0.809) and 84% versus 68% (p=0.0329), respectively. The 5-year local control rates for Mohs and non-Mohs patients were 86% versus 76% (p=0.0606), respectively. The 5-year local-regional control and freedom from distant metastases rates for the Mohs group were 77% and 92%, respectively. The 5-year overall neck control, neck control with elective neck RT, and neck control without elective RT treatment rates for the Mohs group were 91%, 100%, and 82% (p=0.0763), respectively. The rate of grade 3 or higher complication in the Mohs group was 22%, which included bone exposure (N=3), cataract (N=2), chronic non-healing wound (N=2), wound infection (N=1), fistula (N=1), and/or radiation retinopathy (N=1).

Mohs surgery appears to result in improved local control and cause-specific survival in patients with incidental PNI who receive postoperative RT. Elective nodal RT improves regional control in patients with SCC.