Pain as an atypical presentation of squamous cell carcinoma

BACKGROUND. Cancer of the skin may be difficult to diagnose clinically if there are minimal skin findings on examination. OBJECTIVE. To remind physicians that the symptoms of squamous cell carcinoma (SCC) may precede physical signs of the tumor. METHODS. Perineural invasion of SCC was confirmed by histologic examination of surgical specimens. RESULTS. We present two patients whose initial presentation of SCC was facial pain due to extensive perineural invasion. Their diagnoses were delayed until skin lesions eventually became evident months later. CONCLUSION. Early detection can be lifesaving, thus emphasizing the importance of including skin cancer in the differential for facial pain or paresthesia.