Perineural Invasion in Head and Neck Basal Cell Carcinomas: A Major Factor in Mutilating Tumors

Objectives: Basal cell carcinoma is the most frequent neoplasia in Caucasians. Morbidity is mainly related to local invasion. Perineural invasion (PI) was recently included in TNM staging and is rare in this skin malignancy. Our goal was to characterize the cases of basal cell carcinoma with PI submitted to surgery by head and neck surgeons, in its clinical, epidemiological and histopathological features. Methods: From 1994 to 2012, 354 basal cell carcinomas were submitted to surgery under general anesthesia. Sex, age, hystological subtype, localization, size and PI were retrospectively analyzed. The cases with and without PI were compared. Results: PI was positive in 23.1% of the tumors. 58.5% were men, whereas 49.6% were men in the PI negative patients (P = 0.16). Mean age in the positive group was 65.4‚±13.2 years, while in the negative group mean age was 65.0‚±14.4 years (P = 0.8). Mean size of primary tumors in the positive group was 3.8‚±2.2cm and 2.5‚±1.8cm in the negative group (P < 0.01). Morpheaform subtype was predominant in 48.2% in the positive group and 26.4% in the negative group (P < 0,001). Nodular subtype was predominant in 33.7% in the positive and 53.2% in the negative group (P = 0.002). Conclusions: In this series of aggressive and mutilating tumors, with a 8-fold increase of PI, basal cell carcinomas with PI had higher mean tumor size and more frequency of morpheaform as predominant subtype.