Facial pain and multiple cranial palsies in a patient with skin cancer

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Facial pain and multiple cranial palsies in a patient with skin cancer

Springer Milan
DOI: 10.1007/s10194-011-0324-6
  • Brief Report


BRIEF REPORT Facial pain and multiple cranial palsies in a patient with skin cancer Janina Viken • Lars Bendtsen • Klaus Hansen • Morten Katholm • Henning Laursen • Nina Hastrup • Peter Gideon • Messoud Ashina Received: 26 December 2010 / Accepted: 16 February 2011 / Published online: 31 March 2011 � The Author(s) 2011. This article is published with open access at Springerlink.com Introduction Perineural tumor invasion is a rare complication of cancer though well-reported phenomenon among patients with head and neck cancer. Multiple cranial neuropathies as an initial symptom of recurrent neoplasm have been reported in few studies. The latest study by Leach et al. [1] reported multiple cranial nerve involvement in 67% (4 out of 6 patients) of the patient in comparison to 21% (13 out of 62 patients) found in a study of Mendenhall et al. [2]. Facial pain, progressive weakness of the facial nerve and involvement of fifth cranial nerve were the symptoms most often referred by the patients in previous studies [1–5]. The similarities of the symptoms with Bell’s palsy, trigeminal neuralgia or facial pain of uncertain etiology can lead to misdiagnosis and postpone treatment of highly morbid tumors. Here we describe a patient with multiple cranial neuropathies due to perineural spread of squamous cell carcinoma (SCC), whom the diagnostic procedure estab- lishment of a final diagnosis was a long and challenging process because of repetitive non-diagnostic biopsies and negative magnetic resonance imaging (MRI). Case report In January 2005, a 78-year-old male was referred from general practice to the Danish Headache Center for investigation and treatment of right-sided facial pain. He had a recurrent cancer in his right buccal region, and received curettage and electrodesiccation in August 2001, in January 2002, and in October 2002. Each time skin biopsies were obtained. The first and second biopsy showed basal cell carcinoma (BCC), an

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