Perineural metastasis of cutaneous squamous cell carcinoma of the nose and periocular region: A case report

Introduction. Cutaneous squamous cell carcinoma is the second most common malignant skin tumor and predominant affects the head and neck region. Although most cases have a favorable outcome following surgical excision, high-risk tumors-particularly those exhibiting perineural invasion-are associated with aggressive behavior, local recurrence, and metastatic spread. Case Report. We present the case of a 66-year-old woman with highrisk cutaneous squamous cell carcinoma of the nose and glabellar region. Clinical examination and computed tomography demonstrated full-thickness involvement of the nasal pyramid, with destruction of the cartilaginous septum and the right nasal bone. The patient underwent total nasal amputation with R0 resection and local reconstruction. Histopathological analysis revealed a keratinizing squamous cell carcinoma with marked perineural invasion. Although adjuvant radiotherapy was indicated, the patient declined further treatment. Three months after surgery, she developed an orbital metastatic lesion manifesting by ptosis and periorbital swelling. The patient subsequently died due to acute intracranial hemorrhage. Conclusion. This case illustrates the aggressive nature of high-risk cutaneous squamous cell carcinoma with perineural invasion and its potential for rapid metastatic progression despite complete surgical resection. Early identification of histopathological risk factors and timely implementation of adjuvant oncologic therapy are crucial for improving outcomes in patients with perineural invasive cutaneous tumors.