Immunotherapy and Radiation for Clinical Perineural Invasion in Cutaneous Squamous Cell Carcinoma

作者：Renée Morecroft, Jordan Phillipps, Lang Gou, Alok A. Bhatt, Sungjune Kim, Homan Mohammadi, Roxana Dronca, Bently P. Doonan, Ruqin Chen, Yujie Zhao, Hye Seon Kang, Shenduo Li, Jeffrey R. Janus, Phillip Pirgousis, Samip Patel, Oluwafunmilola T. Okuyemi, Elisha M. Singer, Leila Tolaymat, Ashley Wysong, Catherine A. Degesys, Naiara S. Barbosa, Adam L. Holtzman · 发表于：Cancers · 年份：2025 · DOI：10.3390/cancers17243921 · 被引用次数：2 · 研究领域：Nonmelanoma Skin Cancer Studies、Cutaneous Melanoma Detection and Management、Polyomavirus and related diseases

Localized cutaneous squamous cell carcinoma (cSCC) has a favorable prognosis, unlike advanced disease, especially with clinical perineural invasion (PNI), which poses substantial management challenges due to aggressivity and higher recurrence, metastasis, and mortality risks. PNI, a high-risk staging feature, has worse outcomes, particularly when clinically evident rather than incidental. Clinical PNI (cPNI) is evident by clinical symptoms (such as pain, paresthesia, or motor deficits) or radiologic findings, whereas incidental PNI (iPNI) is identified only histologically without associated symptoms or radiologic evidence. PNI remains a novel area with varying practice patterns across institutions. Improving risk stratification and tailoring multidisciplinary approaches are critical for optimizing outcomes. Our review outlines clinical practice patterns at our institution, providing insights into managing cSCC with PNI, focusing on diagnosis, imaging, staging, and emerging immunotherapies. A structured search was conducted using the terms "perineural invasion," "cutaneous squamous cell carcinoma," and "immunotherapy." cPNI has a poor prognosis and requires nuanced clinical decision-making. Surgery and radiation remain central to management. Adjuvant therapy offers substantial survival benefit in cSCC with PNI, with improved disease-free and overall survival compared with surgery alone, supporting its use in appropriately selected high-risk patients. Traditional systemic thera...