Cutaneous squamous cell carcinoma (cSCC) of the head and neck is a common keratinocyte carcinoma, with perineural invasion (PNI) found in approximately 2.5% to 5% of cases.1,2 Head and neck cSCCs can lead to cranial neuropathies, most commonly cranial nerve V (CNV) and cranial nerve VII (CNVII).3 Cranial neuropathies from tumoral PNI may be difficult to diagnose given their slow and sometimes subtle onset. Here we describe 3 cases of cranial neuropathy as the presenting symptom of cSCC. Additionally, the pathophysiology of PNI and its predilection for CNV and CNVII is discussed as well as the importance of appropriate imaging in guiding the diagnosis, workup, and treatment.
