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

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 establishment of a final diagnosis was a long and challenging process because of repetitive non-diagnostic biopsies and negative magnetic resonance imaging (MRI).