Fast Five Quiz: Can You Identify and Properly Treat Worrisome Neck Masses?

Elwyn C. Cabebe, MD


May 01, 2018

For invasive cutaneous squamous cell carcinomas, surgical excision and Mohs micrographic surgery are the primary treatment options; with appropriate patient selection, these techniques have comparable cure rates. Radiation therapy is typically used as an adjuvant to surgery to provide improved locoregional control, but it may be used as primary therapy in patients who are unable to undergo surgical excision.

Most patients present with early-stage tumors, and most of these patients fare well (overall 5-year survival rate, >90%) when the tumors are adequately treated.

Up to 14% of cutaneous squamous cell carcinomas exhibit perineural invasion. Evidence of cranial nerve dysfunction on examination should raise concern of significant perineural invasion. The most frequently involved cranial nerves are the facial and trigeminal nerves, underscoring the importance of assessment of facial movement and sensation. Therefore, every patient with head and neck cutaneous squamous cell carcinomas should undergo systematic evaluation of cranial nerve function.

CT scanning is useful for determining the presence of bone or soft tissue invasion and for evaluating cervical lymph nodes at risk for metastasis. For evaluation of perineural invasion and orbital or intracranial extension, MRI is the preferred imaging modality.

For more on cutaneous squamous cell carcinoma, read here.


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