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SCC Perineural Invasion — SCE Medical Oncology MCQ

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HardMelanoma & SkinSCC Perineural InvasionSCE Medical Oncology

A head-and-neck cutaneous squamous-cell carcinoma has been completely excised. MRI shows clinical perineural spread along a named trigeminal branch towards the skull base, without nodal disease. Which adjuvant radiotherapy approach best addresses the dominant relapse risk?

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Correct answer: C — Treat the primary bed and the involved nerve pathway proximally towards the skull base

Clinical spread along a named nerve can extend proximally beyond the excision field, so specialist planning should cover the primary bed and the involved nerve pathway towards the skull base while respecting organs at risk. Primary-bed treatment alone omits the demonstrated proximal route. Elective nodal treatment alone does not cover perineural disease. Treating only distal branches misses the at-risk named nerve. Observation is inappropriate for radiographically evident clinical perineural spread.

Reference: Perineural invasion in cutaneous squamous-cell carcinoma: implications for treatment (Published February 2007): https://pubmed.ncbi.nlm.nih.gov/17279578/; Royal College of Radiologists radiotherapy dose fractionation, fourth edition (Published 2024; current UK guidance): https://www.rcr.ac.uk/our-services/all-our-publications/clinical-oncology-publications/radiotherapy-dose-fractionation-fourth-edition/