Incidental perineural invasion in NMSC: A retrospective analysis of the QSkin study and a five year follow up in Queensland

Keratinocyte cancers (KC; that is, basal cell carcinomas (BCC) and squamous cell carcinomas (SCC)) are the most common cancers worldwide. Perineural invasion (PNI) by these malignancies is increasingly recognised as an important adverse prognostic factor. The incidence of Perineural Invasion (PNI) in BCC in the literature ranges from 0.18 to 10% and in the case of cutaneous SCC 3–14%.1 Together with an update on the PNI registry, we present the experience of the QSkin Study, the world’s largest prospective cohort study (43,794 participants) focussed on cancers of the skin. In a subsample of QSkin participants, we reviewed the pathology reports of patients with confirmed BCC or SCC from two large service providers in Queensland. Of 9876 histology reports pertaining to BCCs, only 2758 (28%) mentioned the presence or absence PNI and of these only 33 (1.3%) were positive for PNI. Similarly, of 4257 reports pertaining to SCCs, 1679 (39%) reported on PNI and only 9 (0.54%) were positive for PNI. These findings highlight substantial under-reporting of an important prognostic factor for keratinocyte cancers. In addition the prospective analysis on 200 patients with incidental PNI following a 5 year post management period will be presented.
1. Aakriti Gupta, Michael Veness, Brian De’Ambrosis, Dinesh Selva, and Shyamala C Huilgol. Management of squamous cell and basal cell carcinomas of the head and neck with perineural invasion.

Dr. Agnieszka Adams