This study investigated the prognostic significance of different perineural invasion (PNI) patterns in cutaneous squamous cell carcinoma, specifically comparing extensive PNI versus large-caliber nerve involvement as predictive factors for adverse outcomes. The analysis demonstrated that both extensive PNI and large-caliber nerve involvement are independent predictors of local recurrence and metastasis, but extensive PNI pattern may carry even greater prognostic weight. The findings have important implications for staging, surgical planning, and adjuvant therapy decisions in cSCC with PNI.

Both extensive PNI and large-caliber nerve involvement independently predict worse outcomes in cSCC.

Extensive PNI pattern may carry greater prognostic significance than nerve caliber alone for predicting metastasis.

Detailed PNI characterization in pathology reports is essential for guiding adjuvant therapy decisions and surveillance intensity.