Cranial neuropathy secondary to perineural spread of cutaneous malignancies

Skin cancers of the head and neck are common lesions that rarely metastasize or invade cranial nerves. Perineural spread, when present, typically involves cranial nerves V and VII, because of their extensive subcutaneous distributions. Partial or complete facial palsy, facial hypesthesia, and/or pain may occur months to years after excision of a cutaneous malignancy and is often the first manifestation of regional metastasis. Too often, a history of facial skin cancer is not elicited in the evaluation of patients who present with fifth and/or seventh cranial nerve neuropathies. The initial yield from computerized tomography and magnetic resonance imaging is often limited, leaving most patients with the diagnosis of Bell's palsy. The authors herein present their experience with the diagnosis and management of seven patients who developed a fifth or seventh cranial nerve neuropathy an average of 13.4 months following "complete" excision of a regional skin cancer.