Perineural Spread in Squamous Cell Carcinoma of the Face: An Overlooked Facet of Information on Imaging.

A case of malignant cutaneous lesion of the face diagnosed initially as sebaceous carcinoma, subsequently proven to be squamous cell carcinoma is presented. Patient was initially evaluated at an outside institution by computed tomography, which indicated extension of lesion to the maxillary sinus. Patient underwent local resection. Further imaging by magnetic resonance imaging was done for recurrent tumour. Examination revealed extensive, large volume, perineural extension of the disease via infraorbital nerve to the cavernous sinus. Patient was managed with extensive lesion resection, including the skull base component followed up by radiation. Patient showed recurrence despite aggressive management. This case highlights the crucial role of performing an optimal MR imaging of the target region, including skull base, to exclude a perineural extension, as part of assessment of oro-facial malignancy.