Ahn Grace Sora, Hinds Brian, Kolb Frederic, Reisenauer Amy K, Soon Seaver L, Sepahdari Ali R, Bollin Kathryn B, Park Soo J
Department of Dermatology, University of California, San Diego, La Jolla, CA, United States.
Department of Plastic Surgery, University of California, San Diego, La Jolla, CA, United States.
Front Oncol. 2022 May 23;12:846278. doi: 10.3389/fonc.2022.846278. eCollection 2022.
The recent addition of immunotherapy as a treatment modality to surgery and radiation has vastly improved disease control for patients with keratinocyte-derived carcinomas (KCs) that are incurable with local therapies alone. With the advent of immune checkpoint inhibitors (ICPis) in non-melanoma skin cancers comes diagnostic and therapeutic challenges when considering treatment strategies for patients presenting with clinical perineural invasion (cPNI) of locally advanced KC of the head and neck.
We report four cases that convey the diagnostic and therapeutic complexity of managing patients with neuropathic symptoms from cutaneous neurotropic carcinomas of the head and neck. We also discuss an updated review regarding immunotherapies and perineural invasion within KC management.
Patients presenting with symptoms suspicious for cPNI warrant an expanded diagnostic evaluation to correlate neurological findings with neurotropic spread of disease. While nerve biopsies can be precarious in sensitive areas, a history of skin cancer and clinical presentation suggestive of neurotropism may be enough to pursue timely management in the form of surgery, radiation, and/or systemic therapy given each patient's individual priorities, comorbidities, and prognosis. When adding ICPi as a treatment modality for patients with disease not amenable to local therapies, the potential for immune-related adverse events must be considered. A multi-disciplinary review and approach to the management of patients with KC and cPNI is essential for obtaining optimal patient outcomes.
最近，免疫疗法作为一种治疗方式被添加到手术和放疗中，这极大地改善了仅用局部疗法无法治愈的角质形成细胞源性癌（KCs）患者的疾病控制情况。随着免疫检查点抑制剂（ICPis）在非黑色素瘤皮肤癌中的出现，在考虑对头颈部局部晚期KC伴有临床神经周围侵犯（cPNI）的患者进行治疗策略时，出现了诊断和治疗方面的挑战。
我们报告4例病例，这些病例体现了对头颈部皮肤嗜神经癌伴有神经病变症状患者进行管理时的诊断和治疗复杂性。我们还讨论了关于KC管理中免疫疗法和神经周围侵犯的最新综述。
出现疑似cPNI症状的患者需要进行扩展的诊断评估，以将神经学检查结果与疾病的嗜神经扩散相关联。虽然在敏感区域进行神经活检可能存在风险，但鉴于每位患者的个体优先事项、合并症和预后情况，皮肤癌病史和提示嗜神经现象的临床表现可能足以促使以手术、放疗和/或全身治疗的形式及时进行处理。当将ICPi作为不适用于局部疗法的患者的一种治疗方式添加进来时，必须考虑免疫相关不良事件的可能性。对KC和cPNI患者进行多学科评估和管理方法对于获得最佳患者治疗效果至关重要。
