Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines

Abstract

Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN definitions of “high-risk” cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (n = 211,82.1%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (≥2 cm); one tumor was “upstaged” due to “high-risk features.” Using the NCCN taxonomy, 231 (87%) of tumors were “high-risk.” Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of “high-risk” cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are “high-risk” by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of “high-risk” cSCC to optimize management.

Biomarker and Pathologic Predictors of Cutaneous Squamous Cell Carcinoma Aggressiveness

“…13 Additional high-risk factors identified by the National Comprehensive Cancer Network include immunosuppression, neurologic symptoms, and acantholytic, adenosquamous, and desmoplastic tumor histologic subtypes. 13 The presence of these characteristics merit increased concern for potential spread to the parotid, the first site of head and neck cSCC metastasis.…”

High-risk cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy: A literature review

“…In a study that included 269 cases of cSCC, the authors classified 13.9% as T2 using the AJCC-7 criteria; in contrast, using the National Comprehensive Cancer Network (NCCN) criteria, 87% of these lesions (231 tumors) were classified as high risk: These data highlight the lack of consensus in defining HRcSCC. 27 cSCC metastasize via lymphatic vessel spread 28,29 with the extent of regional nodal involvement an important prognostic factor as survival decreases with increasing nodal size and number of involved nodes. 3,14,30 Therefore, it is possible that early detection of subclinical (or occult) nodal disease could lead to fewer deaths from cSCC 31 as opposed to watching and waiting for clinicoradiologic nodal involvement.…”

SLNB in cutaneous SCC: A review of the current state of literature and the direction for the future

“…Validation studies by Schmitt et al comparing these two staging systems, confirms that the alternative staging system more precisely delineates “high‐risk” SCC tumors, as T2b tumors had a statistically higher metastasis rate than T2a tumors . The NCCN guidelines characterize any SCC tumor containing one or more of the defined high‐risk features as a “high risk SCC.” Table includes a comprehensive list of the high‐risk features and includes a comparison between the three sources.…”