The role of supraorbital nerve biopsy in cutaneous malignancies of the periocular region

Purpose: To describe clinical situations in which a biopsy or resection of the supraorbital nerve may play a role in patients in whom perineural invasion secondary to cutaneous head and neck malignancies is suspected. Methods: The clinical records of 230 patients with squamous cell carcinoma (SCCA) of the skin of the head and neck who were treated at the University of Texas M.D. Anderson Cancer Center between April 1994 and March 2001 were reviewed. Thirty-five patients were identified as having primary lesions on the forehead skin. Of these, 8 patients had microscopic or clinical evidence of perineural invasion. Four of these 8 patients had undergone a supraorbital nerve biopsy or resection in the course of their treatment. Although all 4 patients were classified as having had SCCA, 1 patient had a variant of undifferentiated SCCA that more appropriately should have been classified as lymphoepithelioma-like carcinoma. The clinical history was reviewed in each case. The median follow-up time for this cohort was 47 months (range, 24 to 72 months). Results: The 4 cases reported here illustrate that a supraorbital nerve biopsy can help confirm the diagnosis of perineural invasion, identify the extent of tumor infiltration, and help in staging of particularly aggressive cutaneous malignancies of the periocular region. Access to the proximal (orbital) portion of the nerve can be accomplished through an anterior orbitotomy. Conclusions: A biopsy of the peripheral branches of the trigeminal nerve may be indicated as part of the staging or to confirm the diagnosis of perineural invasion in patients with SCCA or other locally aggressive cutaneous malignancies of the head and neck.