Factors Predictive of Recurrence and Death From Cutaneous Squamous Cell Carcinoma: A 10-Year, Single-Institution Cohort Study
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Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes in primary cutaneous squamous cell carcinoma.Abstract:
Importance Although most cases of cutaneous squamous cell carcinoma (CSCC) are easily cured with surgery or ablation, a subset of these tumors recur, metastasize, and cause death. We conducted the largest study of CSCC outcomes since 1968. Objective To identify risk factors independently associated with poor outcomes in primary CSCC. Design A 10-year retrospective cohort study. Setting An academic hospital in Boston. Participants Nine hundred eighty-five patients with 1832 tumors. Main Outcomes and Measures Subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. Results The median follow-up was 50 (range, 2-142) months. Local recurrence occurred in 45 patients (4.6%) during the study period; 36 (3.7%) developed nodal metastases; and 21 (2.1%) died of CSCC. In multivariate competing risk analyses, independent predictors for nodal metastasis and disease-specific death were a tumor diameter of at least 2 cm (subhazard ratios, 7.0 [95% CI, 2.2-21.6] and 15.9 [4.8-52.3], respectively), poor differentiation (6.1 [2.5-14.9] and 6.7 [2.7-16.5], respectively), invasion beyond fat (9.3 [2.8-31.1] and 13.0 [4.3-40.0], respectively), and ear or temple location (3.8 [1.1-13.4] and 5.9 [1.3-26.7], respectively). Perineural invasion was also associated with disease-specific death (subhazard ratio, 3.6 [95% CI, 1.1-12.0]), as was anogenital location, but few cases were anogenital. Overall death was associated with poor differentiation (subhazard ratio, 1.3 [95% CI, 1.1-1.6]) and invasion beyond fat (1.7 [1.1-2.8]). Conclusions and Relevance Cutaneous squamous cell carcinoma carries a low but significant risk of metastasis and death. In this study, patients with CSCC had a 3.7% risk of metastasis and 2.1% risk of disease-specific death. Tumor diameter of at least 2 cm, invasion beyond fat, poor differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors associated with poor outcomes. Accurate risk estimation of outcomes from population-based data and clinical trials proving the utility of disease-staging modalities and adjuvant therapy is needed.read more
Citations
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Journal ArticleDOI
Risk Factors for Cutaneous Squamous Cell Carcinoma Recurrence, Metastasis, and Disease-Specific Death: A Systematic Review and Meta-analysis
TL;DR: All published data on risk factors for recurrence, metastasis, and disease-specific death of cutaneous squamous cell carcinoma is analyzed systematically to systematically analyze the magnitude of association and the quality of evidence.
Journal ArticleDOI
Guidelines of care for the management of cutaneous squamous cell carcinoma
Murad Alam,April W. Armstrong,Christian L. Baum,Jeremy S. Bordeaux,Marc D. Brown,Klaus J. Busam,Daniel B. Eisen,Vivek Iyengar,Clifford W. Lober,David J. Margolis,Jane L. Messina,Alexander R. Miller,Stanley J. Miller,Eliot N. Mostow,Christen M. Mowad,Kishwer S. Nehal,Kristi Schmitt-Burr,Aleksandar Sekulic,Paul A. Storrs,Joyce M.C. Teng,Siegrid S. Yu,Conway C. Huang,Kevin Boyer,Wendy Smith Begolka,Christopher K. Bichakjian,John Y.S. Kim,Jeffrey H. Kozlow,Bharat B. Mittal,Jeffrey S. Moyer,Thomas Olenecki,Phillip Rodgers +30 more
TL;DR: The primary focus of these recommendations is on evaluation and management of primary cSCC and localized disease, but where relevant, applicability to recurrent cS CC is noted, as is general information on the management of patients with metastatic disease.
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Evaluation of American Joint Committee on Cancer, International Union Against Cancer, and Brigham and Women's Hospital Tumor Staging for Cutaneous Squamous Cell Carcinoma
Pritesh S. Karia,Anokhi Jambusaria-Pahlajani,David P. Harrington,George F. Murphy,Abrar A. Qureshi,Chrysalyne D. Schmults +5 more
TL;DR: BWH staging offers improved distinctiveness, homogeneity, and monotonicity over AJCC and UICC staging, and Population-based validation is needed.
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Update on Keratinocyte Carcinomas
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Cutaneous Squamous Cell Carcinoma
TL;DR: This review of cutaneous squamous cell carcinoma covers incidence, recurrence rates, mortality rates, risk factors, staging systems, treatment, prevention, and monitoring.
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