Skin Cancer & Perineural Spread(Squamous Cell Carcinoma)
Addressing complex facial nerve involvement caused by aggressive cutaneous malignancies.
What is Perineural Invasion?
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer. While most cases are successfully treated with minor outpatient procedures (like Mohs micrographic surgery), some aggressive tumors exhibit a behavior known as perineural invasion (PNI).
Perineural invasion occurs when cancer cells identify, attach to, and spread along the pathways of nerves. Because the facial nerve (which controls movement) and the trigeminal nerve (which provides sensation) weave superficially just beneath the skin of the face, they are particularly vulnerable to being hijacked by aggressive skin cancers.
As the tumor tracks along the nerve pathway, it effectively destroys the nerve's ability to transmit electrical signals, leading to profound facial paralysis. Treating these cancers requires extensive oncologic resection (often coordinated with parotid gland surgery) and complex, specialized facial reanimation.
Multidisciplinary Oncologic Care
Facial paralysis resulting from skin cancer requires urgent, multidisciplinary care. If you experience new or worsening facial weakness near a current or previous skin cancer site, it is a significant warning sign of perineural spread.
Complete cancer eradication is always the primary goal. Dr. Jowett works closely with Mohs surgeons, head and neck oncologists, and radiation oncologists to plan for immediate or delayed facial nerve reconstruction, depending on the extent of the disease and your overall treatment plan.
Clinical Signs of Nerve Involvement
Perineural spread can be insidious. Symptoms may develop months or even years after a skin cancer was seemingly removed.
Progressive Weakness
Unlike Bell's Palsy which happens overnight, paralysis from cancer typically worsens slowly over weeks or months, starting in one isolated area (like an eyebrow) and spreading.
Pain or Numbness
Because tumors often invade both motor and sensory nerves, you may experience "formication" (a crawling sensation on the skin), sharp shooting pain, or areas of complete numbness.
Post-Operative Paralysis
If the nerve was directly excised during a Mohs procedure or radical neck dissection to clear the tumor margins, immediate flaccid paralysis will occur on the affected side.
Reconstructive Options
Reconstruction following aggressive skin cancer is highly individualized and must account for missing skin, underlying tissue, and whether radiation therapy is required.
If the cancer is removed with clear margins and the proximal facial nerve (near the brain) is intact, Dr. Jowett can perform immediate nerve grafting. A sensory nerve from another part of the body is spliced in to bridge the gap created by the tumor resection.
Why Choose Revitalis?
Dr. Nate Jowett is a world-renowned expert in facial reanimation. With dual fellowship training in Germany and at Harvard Medical School, he brings a unique engineering and microsurgical background to treating complex facial nerve disorders.
Whether you are days into a diagnosis or have lived with incomplete recovery for years, Dr. Jowett offers the full spectrum of care, from medical management to cutting-edge surgical reconstruction, to help you regain your smile and confidence.
Selected References
- A General Approach to Facial Palsy. Jowett N. Otolaryngol Clin North Am. 2018 Dec;51(6):1019-1031. doi: 10.1016/j.otc.2018.07.002. PMID: 30119926.
- A Contemporary Approach to Facial Reanimation. Jowett N, Hadlock TA. JAMA Facial Plast Surg. 2015 Jul-Aug;17(4):293-300. doi: 10.1001/jamafacial.2015.0399. PMID: 26042960.