+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Peritumoral fibrosis in basal cell and squamous cell carcinoma mimicking perineural invasion: potential pitfall in Mohs micrographic surgery



Peritumoral fibrosis in basal cell and squamous cell carcinoma mimicking perineural invasion: potential pitfall in Mohs micrographic surgery



Dermatologic Surgery 31(9 Pt 1): 1101-1106



Perineural invasion (PI) in cutaneous basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) is linked to an aggressive course. We describe a histologic mimic for PI that we termed peritumoral fibrosis (PF). To describe the morphologic changes associated with PF and to determine the incidence of PF and PI in Mohs frozen sections of BCC and SCC. All cases of BCC and SCC that were treated by Mohs micrographic surgery (MMS) at the Skin and Cancer Center, University of Florida College of Medicine, Gainesville, Florida, and the Center for Dermatology and Skin Surgery, Tampa, Florida, during the period from January 1, 2003, to August 1, 2004, were reviewed for the presence of PI and PF. The latter was defined as the presence of concentric layers of fibrous tissue that either surround and/or were surrounded by tumor formations mimicking perineural or intraneural invasion. Seven hundred six cases of BCC and 264 cases of SCC were surveyed. Eleven cases (10 BCC and 1 SCC) with equivocal areas were destained, and immunohistochemical staining with S-100 protein was performed, proving actual PI in all of these cases. Available original hematoxylin-eosin biopsy slides were correlated with the MMS frozen sections. PF was noticed in 4.5% of SCCs and 5.8% of BCCs. The incidence of unequivocal PI was noted to be 2.6% in SCC and 2.1% in BCC. We describe a specific pattern of fibrosis noted in BCC and SCC that we called PF. It shows concentric layers of fibrous tissue surrounding and/or surrounded by tumor formations and resembles carcinomatous perineural and/or intraneural invasion. Moreover, PF was found to be a sensitive marker for PI. Mohs micrographic surgeons should be aware of this phenomenon to avoid triggering unnecessary steps in managing these cases, such as irradiation.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 049895528

Download citation: RISBibTeXText

PMID: 16164857

DOI: 10.1111/j.1524-4725.2005.31903


Related references

Peritumoral Fibrosis in Basal Cell and Squamous Cell Carcinoma Mimicking Perineural Invasion. Dermatologic Surgery 31(9): 1101-1106, 2005

Cutaneous squamous cell carcinoma treated with Mohs micrographic surgery in Australia II. Perineural invasion. Journal of the American Academy of Dermatology 53(2): 261-266, 2005

Treatment of cutaneous squamous cell carcinoma with perineural invasion using Mohs micrographic surgery: report of two cases and review of the literature. Dermatologic Surgery 35(10): 1559-1566, 2009

Eccrine syringofibroadenoma-like change adjacent to a squamous cell carcinoma: potential histologic pitfall in Mohs micrographic surgery. Dermatologic Surgery 35(3): 519-522, 2009

The perineural corona sign: enhancing detection of perineural squamous cell carcinoma during Mohs micrographic surgery with toluidine blue stain. Journal of the American Academy of Dermatology 71(4): 826-827, 2014

Differences of Mohs micrographic surgery in basal cell carcinoma versus squamous cell carcinoma. International Journal of Dermatology 57(11): 1375-1381, 2018

Basal cell carcinoma treated with Mohs surgery in Australia III. Perineural invasion. Journal of the American Academy of Dermatology 53(3): 458-463, 2005

Photodynamic Therapy Followed by Mohs Micrographic Surgery Compared to Mohs Micrographic Surgery Alone for the Treatment of Basal Cell Carcinoma: Results of a Pilot Single-Blinded Randomised Controlled Trial. Journal of Cutaneous and Aesthetic Surgery 8(2): 88-91, 2015

Management of periocular basal cell carcinoma Mohs micrographic surgery versus radiotherapy I Mohs micrographic surgery. Survey of Ophthalmology 38(2): 193-203, 1993

Test characteristics of high-resolution ultrasound in the preoperative assessment of margins of basal cell and squamous cell carcinoma in patients undergoing Mohs micrographic surgery. Dermatologic Surgery 35(1): 9, 2009

Test Characteristics of High-Resolution Ultrasound in the Preoperative Assessment of Margins of Basal Cell and Squamous Cell Carcinoma in Patients Undergoing Mohs Micrographic Surgery. Dermatologic Surgery 35(1): 9-16, 2009

Perineural spread of basal cell carcinomas treated with Mohs micrographic surgery. Cancer 88(7): 1605-1613, 2000

Recurrence of periocular basal cell carcinoma and squamous cell carcinoma after Mohs micrographic surgery: a retrospective cohort study. British Journal of Dermatology 180(5): 1176-1182, 2019

Squamous cell carcinoma with perineural invasion presenting as a Tolosa-Hunt-like syndrome: a potential pitfall in diagnosis. Ophthalmic Plastic and Reconstructive Surgery 16(6): 450-452, 2000

A Unique Basaloid Proliferation Encountered During Mohs Surgery: Potential Pitfall for Overdiagnosis of Basal Cell Carcinoma. Yearbook of Dermatology and Dermatologic Surgery 2012: 389-390, 2012