Perineural invasion (PNI) describes tumour growth in and around a nerve. It is an uncommon ﬁ nding in non-melanoma skin cancer but has the potential for serious sequelae, most commonly local recurrence in the skin and cranial nerves. Assessment of the severity of PNI is based on clinical, pathological and imaging ﬁ ndings. Clinical problems include sensory and motor abnormalities. Histology helps to clarify the number, size and location of involved nerves. MRI and CT imaging assist in diagnosis and assessment of PNI. Mohs surgery is indicated for the extirpation of cutaneous disease but a multidisciplinary approach with neurosurgi- cal and plastic surgeons and radiation oncologists is required for more extensive disease.