Management of Patients With Primary Cutaneous and/or Salivary Gland Malignancies With Trigeminal Nerve Involvement at Presentation

Advanced head and neck cutaneous and/or salivary carcinomas with cranial nerve involvement pose a complex therapeutic challenge with a lack of consensus regarding optimal management. The current study examines postoperative and oncologic outcomes following upfront surgical resection with a tailored approach depending on the extent of nerve involvement, followed by individualized adjuvant radiotherapy. A retrospective chart review was performed of patients with primary cutaneous or salivary malignancies demonstrating clinical and imaging evidence of trigeminal nerve involvement who underwent surgical resection between 1998 and 2023. Sixty-eight patients were identified, including 21 (30.9%) with cutaneous squamous cell carcinoma and 47 (69.1%) with salivary gland carcinoma. Fifteen patients (71.4%) with cutaneous malignancies and 21 (44.7%) with salivary malignancies had concomitant facial nerve involvement. At 36 months, 56.3% of patients with cutaneous carcinoma and 61.5% of patients with salivary carcinoma who completed treatment remained disease free. Active disease accounted for mortality in 31.3% of patients with cutaneous carcinoma and 41.9% of patients with salivary carcinoma. Cutaneous malignancies were associated with an approximately 3-fold increased likelihood of facial nerve involvement compared with salivary malignancies (odds ratio: 3.1, 95% CI: 0.99-9.7), while no significant differences in disease-free survival or mortality were observed between groups. Proactive surgical resection with cranial nerve sacrifice followed by adjuvant radiotherapy can achieve meaningful disease control with acceptable postoperative morbidity in appropriately selected patients with advanced head and neck malignancy with trigeminal nerve involvement.