How would you treat perineural recurrence of a cutaneous squamous cell carcinoma after initial electron XRT (55 Gy/20 fractions) to the primary site given 1.5 years ago?
The patient had a 1.5 cm squamous cell carcinoma of the right temple with 0.15 mm caliber PNI on initial resection. At the time, there was no clinical or radiographic PNI. The patient received post-op XRT with 6 MeV electrons to 55 Gy/20 fx. Now presenting with multifocal perineural recurrence along the distal and proximal CN V and CN VII.
2 Answers
Mednet MemberInvited Expert
Radiation Oncology · UTMB
Answered on
An unfortunate but not too uncommon situation. Assuming no other sites of disease, it is a curable condition.
Explore immunotherapy first ,with cemiplimab but would need RT eventually to cure - see RAMPART study with promising results presented by Dr. @Dr. First Last at ASCO 2026.
RT parameters: tre...
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Mednet MemberInvited Expert
Radiation Oncology · University of Texas at Tyler
Answered on · Updated on
This patient has serious problems with an early relapse, involvement of two named nerves (Tong et al., PMID 36400852 for a good review of PNI), and possible CN deficits with subclinical or outright brain invasion, with the recurrence involving the 'proximal nerve'. I would recommend:
- A thin-cut, con...
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