Journal Scan / Review · October 03, 2017

A New Risk-Stratification System for Cutaneous Squamous Cell Carcinoma

Journal of the American Academy of Dermatology

TAKE-HOME MESSAGE

The authors of this review propose a new evidence-based risk stratification system for cutaneous squamous cell carcinoma (cSCC) that divides tumors into low-, intermediate-, and high-risk subsets, taking into account both tumor and patient characteristics. The authors define low-, intermediate-, and high-risk cSCC based on both the Brigham and Women's Hospitals (BWH) cSCC staging system and the absolute risk for local recurrence and nodal metastases. Low-risk cSCC comprises BWH T1 and T2a tumors and has an absolute risk of local recurrence and nodal metastases of 5% and 3%, respectively. In contrast, high-risk cSCC comprises BWH T2b and T3 tumors and has >20% absolute risk of local recurrence and nodal metastases. Low-risk cSCC should be followed annually, intermediate-risk cSCC every 6 to 12 months for 2 years, then annually, and high-risk cSCC every 2 to 4 months for 2 years, then annually.
A small percentage of cSCC are associated with local recurrence, nodal metastases, and death, and an evidence-based risk-stratification system that identifies patients at highest risk for these outcomes may improve patient management.
– Jeffrey Scott, MD

Journal of the American Academy of Dermatology

Abstract:

Most primary cutaneous squamous cell carcinomas are cured with surgery. A subset, however, may develop local and nodal metastasis that may eventuate in disease-specific; death. This subset has been variably termed high risk. Herein, we review; an emerging body of data on the risks of these outcomes and propose an evidence-based; risk stratification for low-, intermediate-, and high-risk tumors that takes into; account both tumor and patient characteristics. Finally, we discuss a framework for; management of these tumors on the basis of data, when available, and our; recommendations when data are sparse.