Cavernous sinus syndrome secondary to trigeminal nerve invasion by cutaneous squamous cell carcinoma: A case report and brief review

Abstract

Objectives: Cutaneous squamous cell carcinoma (cSCC) has a broad clinical spectrum, especially when it affects the head and neck. Given the possible presentations, there is perineural dissemination, with an unfavorable prognosis and involvement of less differentiated tumor cells. A possible outcome is cavernous sinus syndrome (CSS), which encompasses the cavernous sinus, an anatomical structure that includes the oculomotor, trochlear, abducens nerves and the V1 and V2 branches of the trigeminal nerve. Methods: We present a 62-year-old white man who manifested unilateral progressive ptosis, binocular diplopia and supraorbital pain in the right eye. Results: The relevant history of skin neoplasms on the head raised the diagnostic hypothesis. Neuroimaging evaluation demonstrated nerve infiltration of the trigeminal nerve with tumor expansion at the level of the ipsilateral cavernous sinus. Discussion: The concomitance between cSCC and CSS correlates with the participation of the neural growth factor and the overexpression of programmed cell death protein 1 (PD-1), with dermatological and neurological manifestations. In this context, the standard treatment used is cemiplimab, an immunotherapy used in unresectable and metastatic tumors and recently emerging as neoadjuvant therapy in surgical cases. The present report illustrates the association of such entities with the use of the described monoclonal antibody.

Keywords

• Cavernous sinus syndrome
• Squamous cell carcinoma
• Perineural invasion
• Cavernous sinus
• Cemiplimab