[Intracranial extension of cutaneous facial squamous cell carcinoma: involvement of the neurotropic pathway]. / Extension intracrânienne d'un carcinome spinocellulaire de la face : implication de la voie neurotrope.

ABSTRACT

BACKGROUND: Squamous cell carcinoma is the most common form of skin cancer after basal cell carcinoma. It comprises locoregional malignant tumours with more rapid and severe spread, and which may metastasise through blood or lymph, and through a less well-known neurotropic pathway. We report a case of late and slowly progressive recurrence of squamous cell carcinoma revealed and characterized by neurological symptoms alone. OBSERVATION A 69-year-old woman with a history of cutaneous squamous cell carcinoma on the left nostril edge removed 10 years earlier presented right trigeminal neuralgia in 2003. These symptoms gradually expanded and in 2007 a subcutaneous induration of the two cheeks appeared. Magnetic resonance imaging (MRI) showed subcutaneous infiltration of the 2 nasolabial sulci, as did contrast enhancement of the two trigeminal nerves up to the cavernous sinuses. Deep biopsy allowed a diagnosis of invasive squamous cell carcinoma to be made. DISCUSSION: Neurotropism is an important feature of squamous cell carcinoma, and reveals the aggressive nature of this condition. This feature makes it hard to diagnose relapse since the neurological symptoms may be isolated for a long period, hence the need for systematic screening for perineural tumour sites on histological analysis of the initial lesion. Treatment for these forms is limited and for the moment consists of radiation, cetuximab and a combination of these two treatments.