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A man in his 60s presented to a tertiary care center after several months of having right-sided lateral neck pain. He described the pain as “electric” and “stabbing.” He reported no numbness of the region and had not experienced any other symptoms, including new neck masses. His medical history was significant for obstructive sleep apnea, gastroesophageal reflux disease, a right ear skin cancer excised by a dermatologist, and coronary artery disease with angina on stress test. His physical examination revealed a well-healed excision site of the right ear without new skin lesions. His facial nerve was fully intact. He had full strength of the shoulder and no numbness of the right ear or cheek. Palpation of the lateral neck demonstrated a mass running along the lateral border of the sternocleidomastoid (SCM) muscle. Magnetic resonance imaging (MRI) showed an elongated enhancing tubular structure along the lateral surface of the right SCM muscle (Figure 1).
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D. Perineural spread of cutaneous squamous cell carcinoma
Perineural spread (PNS) is a metastatic process in which cancer invades nearby nerve tissue and spreads along the nerve within the perineurium and endoneurium away from the primary tumor. This results in radiographic changes of the nerve as well as clinical signs and symptoms, including nerve dysfunction, pain, or mass. Spread of disease within nerves is usually quickly progressive owing to a relatively unimpeded path of invasion. PNS is distinct from incidental perineural invasion (PNI), which is the discovery of tumor invasion into nearby nerves during pathologic review.1- 5 PNS has been linked to a worse overall prognosis and thus higher staging of tumors, with a 5-year overall survival rate ranging from 50% to 64%.5,6 Within the head and neck, PNS is commonly seen within the trigeminal nerve causing hypoesthesia, anesthesia, or pain and the facial nerve causing paresis or paralysis, hyperacusis, or taste dysfunction.1,5,7 It is associated with adenoid cystic carcinoma, basal cell carcinoma, squamous cell carcinoma (SCC), and melanoma.1,6
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Corresponding Author: Kevin Higgins, MD, MSc, FRCSC, Department of Otolaryngology–Head and Neck Surgery, Sunnybrook Health Sciences Centre, 2075 Bayview Ave, Toronto, ON M4N 3M5, Canada (firstname.lastname@example.org).
Published Online: March 29, 2018. doi:10.1001/jamaoto.2018.0019
Conflict of Interest Disclosures: All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest, and none were reported.
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