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AJNR - American Journal of Neuroradiology

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American Journal of Neuroradiology 25:5-11, January 2004
© 2004 American Society of Neuroradiology

HEAD AND NECK

Perineural Spread of Malignant Melanoma of the Head and Neck: Clinical and Imaging Features

Patrick C. Chang^a, Nancy J. Fischbein^a, Timothy H. McCalmont^b, Mohammed Kashani-Sabet^c, Elizabeth M. Zettersten^c, Amon Y. Liu^d and Jane L. Weissman^e

^a Department of Radiology, University of California, San Francisco, School of Medicine, San Francisco, CA
^b Department of Dermatopathology, University of California, San Francisco, School of Medicine, San Francisco, CA
^c Department of Dermatology, University of California, San Francisco, School of Medicine, San Francisco, CA
^d Department of Radiology, Medical College of Virginia, Richmond, VA
^e Departments of Radiology and Otolaryngology, Oregon Health Sciences University, Portland, OR

Address correspondence to Nancy J. Fischbein, MD, Department of Radiology, University of California, San Francisco, School of Medicine, Box 0682, 505 Parnassus Avenue, San Francisco, CA 94143

BACKGROUND AND PURPOSE: Extension of malignant melanoma along cranial nerves is a little-known complication of malignant melanoma of the head and neck. We describe the clinical and MR imaging findings of perineural spread of malignant melanoma to cranial nerves, emphasizing that this entity occurs more commonly with desmoplastic histology and may have a long latent period following primary diagnosis.

METHODS: At two institutions, we identified and retrospectively reviewed eight cases of malignant melanoma of the head and neck that had MR imaging evidence of perineural spread of disease. All patients underwent confirmatory tissue sampling.

RESULTS: Seven patients had melanomas of the facial skin or lip, and one patient had a primary sinonasal lesion. By histopathology, these melanomas included five desmoplastic, two mucosal, and one poorly differentiated melanotic spindle-cell tumor. All patients developed symptomatic cranial neuropathy an average of 4.9 years from the time of initial diagnosis. MR imaging demonstrated postgadolinium enhancement of at least one branch of the trigeminal nerve in all cases and of at least one other cranial nerve in five cases. Other findings included abnormal contrast enhancement and soft tissue thickening in the cavernous sinus, Meckel’s cave, and/or the cisternal segment of the trigeminal nerve.

CONCLUSION: Although perineural spread of disease occurs most commonly with squamous cell carcinoma and adenoid cystic carcinoma, malignant melanoma must also be included in this differential diagnosis, particularly if the patient’s pathology is known to be desmoplastic. Similarly, any patient with malignant melanoma of the head and neck who undergoes MR imaging should receive an imaging assessment focused on the likely routes of perineural spread.

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