Perineural Spread to the Cavernous Sinus from Cutaneous SCCa

PATIENT 1 65 y/o M with history of previous resection of cutaneous SCCa of right cheek. Presented to clinic in 2008 with two year history of progressive right facial weakness, diplopia and pain in a trigeminal distribution. Had already undergone craniotomy with nondiagnostic biopsy because of concerns regarding cavernous sinus. On exam had right ophthalmoplegia and facial paralysis; no obvious skin involvement. MRIs were equivocal however PET scan showed hypermetabolic activity in right midface corresponding to infraorbital nerve. Subsequent biopsy of the infraorbital nerve at the foramen demonstrated patient to have tumoral involvement . Treated palliatively in December 2008 with IMRT which improved pain. However, in September 2009 presented to follow up with worsening pain; MRI showed disease progression. Perineural Spread to the Cavernous Sinus from Cutaneous SCCa