Lightning Talk Skin Cancer 2024

Current management for cutaneous basal cell carcinomas with perineural invasion and involved margins following primary excision (#243)

Amelia Perri 1 , David Whiteman 2 , Benedict Panizza 1 , Duncan Lambie 1 3 , Lachlan J McDowell 1 , Julie Moore 4 , Jessica Zhuang 5 , Jessica Witherspoon 5 , Robbie Honore 6 , Georgia De'Ambrosis 7 , Nikhil Dwivedi 1 , Brian De’Ambrosis 8 9
  1. The Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
  2. QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
  3. Pathology Queensland , Brisbane, Queensland, Australia
  4. Cancer Alliance Queensland, Woolloongabba, Queensland, Australia
  5. Sunshine Coast Hospital and Health Service, Sunshine Coast, Queensland, Australia
  6. University of Queensland, St Lucia, Queensland, Australia
  7. Gold Coast Hospital and Health Service, Gold Coast, Queensland, Australia
  8. South East Dermatology, Brisbane, Queensland, Australia
  9. Faculty of Medicine, The University of Queensland, St Lucia, Queensland, Australia

Aims: To provide an update on management of cutaneous basal cell carcinoma with perineural invasion (cBCCwPNI) with involved margins following primary excision (i.e., re-excision, adjuvant radiotherapy (ART)) and recurrence rates. Also, to present data from the Queensland PNI group’s retrospective analysis of cBCCswPNI from 2009-17.

Methods: A retrospective analysis of patients in Queensland histologically diagnosed with primary cBCCwPNI between 2009-2017 was conducted in collaboration with Cancer Alliance Queensland (CAQ). Patients were identified using the Queensland Oncology Repository, which identifies all patients diagnosed with keratinocyte cancers from Queensland public hospitals via linked pathology providers. Demographics, tumour/nerve factors, and ART use were reviewed. 

Results: 416 cBCCwPNI were identified between 2009-2017. Following primary excision, 137 cases (32.9%) had involved margins. Of the 137 patients, we identified four Groups: (G1) no re-excision & no ART (n=42; 30.7%), (G2) re-excision & no ART (n=53; 38.6%), (G3) no re-excision & ART (n=32; 23.4%) and (G4) re-excision & ART (n=10; 7.3%). Of the 137 patients, 20 (14.6%) had recurrence. G1 had 2 recurrences (4.8%), G2 had 7 recurrences (13.2%), G3 had 7 recurrences (21.9%), G4 had 4 recurrences (40.0%).

Discussion: Current guidelines recommend cBCCswPNI be discussed within a multidisciplinary team for consideration of ART. Adams et al recommend that cBCCswPNI <0.1mm may be treated with Mohs surgery or excision alone (with adequate margins) without ART1. Management lacks consensus due to limited reporting of cases, especially nerve specific features2,3.

Conclusion: Management varies for cBCCswPNI in Queensland, with variable outcomes. Evidence-based approaches are needed to guide management.

 

 

 

 

  1. 1. Adams A, De'Ambrosis B, Panizza B, et al. Keratinocyte cancer with incidental perineural invasion: A registry analysis of management and 5-year outcomes. Australas J Dermatol. Aug 2020;61(3):226-230. doi:10.1111/ajd.13290
  2. 2. Abushukur Y, Ibrahim Y, Cascardo C, Keeley J, Knackstedt T. Basal Cell Carcinoma With Perineural Invasion: A Systematic Review and Pooled Survival Analysis. Dermatol Surg. Nov 1 2022;48(11):1159-1165. doi:10.1097/dss.0000000000003593
  3. 3. Ash MM, Lacy FA, Patel J, Varma R. Surgery Alone (Without Adjuvant Radiation) Adequately Treats Histologic Perineural Basal Cell Carcinomas: A Systematic Review With Meta-Analysis. Dermatol Surg. Jan 1 2023;49(1):1-7. doi:10.1097/dss.0000000000003640