Purpose
To discuss a rare case of recurrent squamous cell carcinoma (SCC) presenting at an advanced stage over a decade from initial treatment, with ipsilateral neuralgia due to perineural infiltration as the initial sole manifestation.
Methods
This case report describes the presentation of a patient with perineural infiltration due to recurrent SCC presenting eleven years following the initial primary resection.
Case Presentation
An 88-year-old Caucasian male presented with a two-month history of neuralgia of the trigeminal ophthalmic and maxillary distributions following right eye evisceration due to recurrent ipsilateral herpes simplex keratitis, failed corneal graft and phthisical eye. His medical history included protracted cutaneous malignancies, the last significant lesion greater than ten-years prior, which the patient had no clear recollection of details and medical notes unobtainable. Differential diagnosis at the time included post-evisceration pain, post-herpetic trigeminal neuralgia and PNI. MRI revealed enhancement of the trigeminal nerve, with no other pathologies identified. He was managed for trigeminal herpetic neuronitis/ganglionitis, however was recalcitrant to valacyclovir, steroids and analgesia. Sequential MRI revealed further trigeminal nerve enhancement, with a late subcutaneous nodular change in the right malar dermis. Histopathology of this nodule revealed SCC recurrence with perineural invasion and he was managed with palliative radiotherapy. Investigative work eventually revealed the initial primary right cheek lesion was an incompletely excised SCC managed with local radiotherapy eleven-years prior.
Conclusion
This case describes the rare presentation of recurrent SCC with perineural invasion more than a decade following the primary resection and adjuvant radiotherapy. The diagnosis of neuralgia was confounded by the co-morbid herpes simplex disease, without cutaneous evidence of SCC recurrence. It is uncommon for recurrence to present at such a late stage with perineural invasion as the initial manifestation. This case aims to highlight the significance of considering malignant perineural invasion in cases of undifferentiated trigeminal neuropathy.