Clinical Management of Cutaneous Head and Neck Squamous Cell Carcinoma with Trigeminal Nerve Involvement: A Systematic Review

Introduction: Cutaneous squamous cell carcinoma of the head and neck (cHNSCC) is the second most common cancer in the world with a typically favorable prognosis. Perineural invasion (PNI) and/or perineural spread (PNS) dramatically reduces survival outcomes and overall prognosis. The trigeminal nerve (CN V) and its branches are most commonly affected and provide abundant opportunities for skull base and intracranial cavity invasion. Treatment often involves a combined approach with surgery and radiotherapy (RT).

Objective: The purpose of this study was to perform a systematic review on the clinical management of cHNSCC with CN V involvement in order to elucidate potential avenues for improvement.

Method: A systematic review was performed in accordance with the established guidelines of Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA statement). Chi-squared analysis was then performed.

Result: Of 3,195 studies initially gathered, 58 studies met criteria for inclusion. There were 185 cases of cHNSCC with CN V involvement, of which the mandibular nerve and its branches (33.3%) were most frequently affected. Combination surgery and RT was the most common treatment modality (48.6%). Recurrence occurred in 14.1% of patients. Sixty-seven patients were reportedly in remission at study follow-up, while 34 patients had died due to their disease. Chi-squared analysis revealed significantly less recurrence among patients treated with combination therapy compared to other treatment protocols (p < 0.021). Patients with V3 involvement had higher morality with a 44% morality, compared to 26% in V1 and 16% in V2 (p < 0.018).

Conclusion: cHNSCC is a relevant neurosurgical entity with high rates of CN V involvement and skull base invasion. Combination surgery and RT is significantly more effective in achieving locoregional control compared to other treatment models. V3 involvement portends a worse prognosis with a significantly higher mortality compared to V2 or V1 involvement.

Publication History

Article published online:
05 February 2024