Cutaneous melanoma the 3rd most commonly diagnosed cancer in 2020, encompassing 11% of all new cancer diagnoses, and most commonly affects younger populations 1,2. Between 10 – 20% of melanomas involve the head and neck and warrant appropriate investigation and management2. A harbinger of morbidity and mortality is perineural spread of the tumour, due its propensity to circumvent surgical margins or radiotherapy, have higher rates of recurrence, and an associated poor prognosis2. The nerves of the head and neck are vast, and represent a highway...

Databases searched included PubMed, Ovid Medline, Embase and CINAHL. The final search returned 3,004 articles. 1768 were reviewed after duplicates removed. After exclusion, 20 articles involving 31 cases were included for analysis. Data extracted from each article included patient demographics, anatomical site of initial melanoma, anatomical site of perineural spread, histological characteristics, recurrence, management, whether the tumour had been previously resected and mortality.

31 cases were analysed with a mean age of 57, and male predominance (64%). 51% of cases involved desmoplastic melanoma (16/31), 22% unclear subtype (7/31), 10% lentigo maligna melanoma (3/31), 6% nodular melanoma (2/31), 6% spindle cell melanoma (2/31), 3% superficial spreading (1/31), 3% primary neurotropic melanoma (1/31). The trigeminal nerve was the most commonly involved nerve (64%). Facial paraesthesia (45%) and trigeminal neuralgia (45%) were the most common presenting features of perineural spread. Imaging findings included an enhancing and enlarged nerve with enhancing or...

Melanoma, and particularly the desmoplastic subtype, is a highly invasive and morbid disease when involving the head and neck. Perineural spread is associated with extension to skull base, and has a high mortality rate. Patients with previous melanoma should be treated with a high degree of suspicion for perineural spread if presenting with new neurological symptoms. The assessment for perineural invasion in melanoma should utilise MRI imaging to identify an enlarged and enhancing nerve, with enhancing or enlarged neural foramina, de-innervated/atrophic masticators and involvement of...

Czarnecki, D. The incidence of melanoma is increasing in the susceptible young Australian population. Acta Dermato-Venereologica 2014; Volume 94(No. 5):pp. 539-541. Cancer Australia. Melanoma of the skin statistics. Australia: Australian Institute of Health and Welfare. Updated 5 Jan 2022; cited 14 Feb 2022. Available from: https://www.canceraustralia.gov.au/cancer-types/melanoma/statistics. Daryanani D, Plukker J, de Jong M, Haaxma-Reiche H, Nap R, Kuiper H, Hoekstra H. Increased incidence of brain metastases in cutaneous head and neck melanoma. Melanoma Research 2005; Volume 15(No 2): pp: 119-124.