Skull Base Invasion Patterns and Survival Outcomes of Nonmelanoma Skin Cancers

Abstract

Report routes of skull base invasion for head and neck nonmelanoma skin cancers (NMSCs) and their survival outcomes. Retrospective. Ninety patients with NMSC with skull base invasion between 2004 and 2014. Demographic, tumor characteristics, and treatments associated with different types of skull base invasion and disease-specific survival (DSS) and overall survival (OS). Perineural invasion (PNI) to the skull base occurred in 69% of patients, whereas 38% had direct skull base invasion. Age, histology, orbital invasion, active immunosuppression, cranial nerve (CN) involved, and type of skull base invasion were significantly associated with DSS and OS ( < 0.05). Patients with basal cell carcinoma (BCC) had significantly improved DSS and OS compared with other histologies ( < 0.05). Patients with CN V PNI had significantly improved DSS and OS compared with CN VII PNI ( < 0.05). Patients with zone II PNI had significantly improved DSS and OS compared with those with direct invasion or zone III PNI ( < 0.05). Nonsurgical therapy was rarely used and is associated with a reduction in DSS and OS ( < 0.05). Patterns and survival outcomes for NMSC skull base invasion are reported. Zone II PNI, BCC, and CN V PNI are associated with improved survival outcomes.

Elective Neck Dissection for Head and Neck Cutaneous Squamous Cell Carcinoma with Skull Base Invasion

“…We have described skull base invasion patterns and survival outcomes of nonmelanoma skin cancers and found that the route and extent of skull base invasion significantly affect disease-specific and overall survival. 10 For these patients, the success of initial surgical treatment relies heavily on accurate clinical judgment of the magnitude of disease spread to achieve resection with negative margins. 11 Magnetic resonance imaging (MRI) can delineate large nerve perineural spread classified according to the degree of skull base involvement 12 and is valuable for determining zonal classification: peripheral (zone 1), skull base (zone 2), and central (zone 3).…”

Surgery Alone (Without Adjuvant Radiation) Adequately Treats Histologic Perineural Basal Cell Carcinomas: A Systematic Review With Meta-Analysis

“…Although current guidelines recommend considering adjuvant RT for extensive or clinical PNBCC, the management of histologic PNBCC has remained undefined. 9,12,13,31 Our meta-analysis demonstrated statistical equivalence between Surg + RT and surgery alone for histologic PNBCC with an overall excellent local control and cancer-specific survival.…”

“…giant BCC, orbital wall invasion, or skull base invasion). 2,6,10,12,17,24,29,31,33–56 Given the propensity for basosquamous disease to act more like SCC with a higher risk of lymph node involvement and metastasis, basosquamous carcinoma studies were not included and cases were excluded whenever possible. 57 No randomized, controlled trials or systematic reviews were identified.…”

“…7,13,[19][20][21][22][23][24][25][26][27][28][29] The clinical management of PNBCC is further obscured because outcome data are often grouped with PNSCC outcomes which seem to have worse tumor biology, a lower overall survival, a higher risk of metastasis, and death. 30,31 As evidenced by improved local control by Jackson and colleagues (97% vs 84%), histologic PNBCC may not be equivalent to histologic PNSCC. [32][33][34] Currently, histologic PNBCC management is guided by single-institution experience, small case series, and expert opinion.…”