Authors: Aaron S. Farberg, Alison L. Fitzgerald, Sherrif F. Ibrahim, Stan N. Tolkachjov, Teo Soleymani, Leah M. Douglas, Sarah J. Kurley & Sarah T. Arron
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, and the number of deaths due to cSCC is estimated to be greater than the number attributed to melanoma. While the majority of cSCC tumors are resectable with clear margins by standard excision practices, some lesions exhibit high-risk factors for which there is evidence of their association with recurrence, metastasis, and disease-specific death. The most commonly used staging systems and guidelines in the USA for cSCC are based on these clinical and pathologic high-risk factors; however, these are limited in their ability to predict adverse events, thus posing a challenge for implementing risk-directed patient management. Since the development of local recurrence and/or metastasis has a profound impact on the survival of patients with cSCC, accurate identification of patients at high risk for poor outcomes is critical, potentially allowing for early and appropriate adjuvant therapy. This review summarizes the current cSCC literature with a focus on how differing clinical assessments within each of the five selected risk factors (perineural invasion, differentiation, depth of invasion, size, and location) can influence the evaluation of patient outcomes, along with summarizing the utility of staging and guidelines, and highlighting the potential for molecular tools to improve upon cSCC risk assessment.
Key Summary Points |
Cutaneous squamous cell carcinoma (cSCC) is recognized as the second most common skin cancer, with studies estimating increases in incidence of between 50% and 200% over the past 30 years. |
Current methods for risk assessment in cSCC are heterogenous, relying on the incorporation of high-risk tumor characteristics, as defined by current staging systems. |
Identification of novel biomarkers to improve the prognosis of cSCC and incorporation of risk prognostication methods may significantly contribute to the development of more precisely targeted therapies and serve as a potential opportunity to improve upon and help standardize the treatment of cSCC. |
This article will review over 10 years of the most relevant literature assessing the following risk factors currently relied upon in clinical practice to guide patient management: perineural invasion, differentiation, depth of invasion, size, and location, along with reviewing staging systems used in the USA, and evaluating the potential for molecular tools to enhance current risk assessment for cSCC patients. |