Perineural spread as the presenting symptom for cutaneous squamous cell carcinoma

Recurrent cutaneous squamous cell carcinoma (cSCC) may rarely present with symptoms of perineural spread (PNS) or perineural invasion (PNI), which may not be noted on initial pathology. Because PNS can mimic benign neuropathies, patients with this manifestation often experience diagnostic delays, especially when PNI is not initially detected. This case report describes a patient who experienced persistent and progressive neurologic symptoms for more than a year before imaging revealed recurrent cSCC involving the cervical nerve roots, despite initial evaluations and imaging failing to detect PNS or PNI. It highlights the need to closely follow and perform repeat evaluations for patients with persistent symptoms without a definitive diagnosis.