Impact of radiographic findings on prognosis for skin carcinoma with clinical perineural invasion

BACKGROUND. The objective of the current study was to correlate pretreatment computed tomography and magnetic resonance imaging studies with outcomes for patients with squamous or basal cell carcinoma of the skin and clinical perineural invasion. METHODS. Between 1986 and 2002, 45 patients were treated with radiotherapy alone (21 patients) or combined with surgery (24 patients), and 4 patients received concomitant chemotherapy. Follow-up ranged from 0.85 years to 17.4 years (median, 3.8 years). Patients were stratified as follows: imaging negative, 10 patients; minimal or moderate peripheral disease, 14 patients; and central and/or macroscopic disease, 21 patients. RESULTS. The 5-year local control rates were as follows: imaging negative, 76%; minimal or moderate peripheral disease, 57%; and central and/or macroscopic disease, 25%. The 5-year absolute and cause-specific survival rates were as follows: imaging negative, 90% and 100%, respectively; minimal or moderate peripheral disease, 50% and 56%, respectively; and central and/or macroscopic disease, 58% and 61%, respectively. CONCLUSIONS. Patients who had symptomatic but imaging-negative perineural invasion had a relatively good prognosis after receiving definitive radiotherapy alone or combined with surgery. Patients who had imaging-positive minimal or moderate peripheral disease had a better local control rate but a similar survival rate compared with patients who had central and/or macroscopic disease.