Perineural spread of tumor along infraorbital nerve
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Staging of malignant spindle cell tumor of left cheek (biopsied)
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Enhancing mass in the subcutaneous fat of the left alar-nasal sulcus passing posteriorly into and expanding the infraorbital nerve along the floor of the left orbit to enter the pterygopalatine fossa. Note persistent minor asymmetrical enlargement of the left maxillary nerve in the foramen rotundum (arrow).
Perineural spread of skin cancer (especially squamous cell carcinoma) is well-recognized and should be evaluated in every such case. In this patient the cancer is not cutaneous rather a malignant soft tissue (spindle cell) sarcoma with perineural spread. This will definitely determine management since complete surgical excision is not possible.