Nodal staging of high-risk cutaneous squamous cell carcinoma

Fox, Matthew C.; Brown, Marc D.; Golda, Nicholas; Goldberg, Dori; Miller, Christopher J.; Pugliano‐Mauro, Melissa; Schmults, Chrysalyne D.; Shin, Thuzar M.; Stasko, Thomas; Xu, Yaohui; Nehal, Kishwer S.; Workgroup, High Risk Squamous Cell Carcinoma

doi:10.1016/j.jaad.2018.09.006

Cited by 37 publications

(45 citation statements)

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“…The diagnosis of cSCC should prompt a complete and careful physical examination including full-body skin examination and evaluation of the skin surface of the primary site for the presence of in-transit metastasis. Although the global risk of lymph node involvement is relatively low (as much as 5%) in invasive cSCC [35], all patients should undergo a careful clinical examination of the regional lymphatic basins via palpation [36,119]. This approach is sufficient in most low-risk cSCC.…”

Section: Physical Examinationmentioning

confidence: 99%

“…1). Imaging methods like ultrasonography (US), computed tomography scan (CT) or positron emission tomography computed scan (PET-CT) are more sensitive than clinical examination [119,120,122]. There are limited data on the use of US for nodal metastasis for cSCC.…”

Section: Nodal Imagingmentioning

confidence: 99%

“…As lymph node metastases from cSCC may be more superficial and easier to detect on US than those from mucosal SCC, US may be a promising cost-effective minimally invasive staging modality for lymph nodes [119].…”

Section: Nodal Imagingmentioning

confidence: 99%

“…underlying structures (orbital invasion, PNI), additional imaging tests, such as CT or MRI may be required to accurately assess the extent of the tumor and the presence of metastatic spread [107,124e126]. MRI is indicated for subtle intracranial disease, perineural spread [119], and imaging of tumor invasion in surrounding soft tissue [124,126]. CT scan and PET-CT are excellent techniques for the detection of metastatic involvement in distant organs [126] (Fig.…”

Section: Uicc/ajcc Tnm Classification 8th Editionmentioning

confidence: 99%

See 3 more Smart Citations

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

Stratigos

Garbe²,

Dessinioti

et al. 2020

European Journal of Cancer

173

233

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Section: Physical Examinationmentioning

confidence: 99%

Section: Nodal Imagingmentioning

confidence: 99%

Section: Nodal Imagingmentioning

confidence: 99%

Section: Uicc/ajcc Tnm Classification 8th Editionmentioning

confidence: 99%

See 2 more Smart Citations

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

Stratigos

Garbe²,

Dessinioti

et al. 2020

European Journal of Cancer

173

233

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“…Finally, the inclusion of vermilion cSCC is a recurrent bias, as the risk of nodal metastasis is 5 times greater compared with hair-bearing lip cSCC (32). Some authors suggest that we should encourage SLNB (or radiotherapy to nodal basin) for patients with BWH stage T3 cSCC and consider it for T2b patients (33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous Squamous Cell Carcinoma Tumour Size is Associated with Sentinel Lymph Node Metastasis in a Cohort of 69 Patients

Chabrillac¹,

Lusque²,

Cavallier³

et al. 2019

Acta Derm Venereol

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SIGNIFICANCEAmong patients presenting a cutaneous squamous cell carcinoma, this study analyses the patient's and tumour's characteristics associated with metastasis in the first draining lymph node, called the "sentinel lymph node". The results show that a large tumour size is a risk factor for lymph node metastasis.Ten to fifty percent of high-risk cutaneous squamous cell carcinoma may potentially metastasize. However, the concept of sentinel lymph node biopsy remains controversial for cutaneous squamous cell carcinoma. The aim of this study was to identify prognostic factors associated with sentinel lymph node positivity. A bicentric retrospective analysis was conducted between January 2006 and January 2018. All patients undergoing sentinel lymph node biopsy for high-risk cutaneous squamous cell carcinoma were included, based on the criteria of the prognostic classification of the French Society of Dermatology. Seventy-four patients were included. Five (6.8%) procedures failed. Of the 69 patients assessed, the positive sentinel lymph node biopsy rate was 11.6% (n = 8) with a false negative rate of 5.7% (n = 4). The positivity of sentinel lymph node biopsy was associated with tumour size (p = 0.0194). Sentinel lymph node biopsy is an effective staging procedure for clinically N0 high-risk cutaneous squamous cell carcinoma, with an acceptable morbidity. To date, 2 risk factors of sentinel lymph node positivity have been identified with statistical significance: tumour size and poor tumour differentiation.

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Performance of the American Joint Committee on Cancer Staging Manual, 8th Edition vs the Brigham and Women’s Hospital Tumor Classification System for Cutaneous Squamous Cell Carcinoma

et al. 2019

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Brigham and Women's tumor classification (BWH) better predicts poor outcomes than American Joint Committee on Cancer (AJCC) 7th edition (AJCC 7). AJCC 8th edition (AJCC 8) has not been evaluated. OBJECTIVES To compare BWH and AJCC 8 tumor classifications for head and neck cutaneous squamous cell carcinoma (HNCSCC). DESIGN, SETTING, AND PARTICIPANTS A total of 459 patients with 680 HNCSCCs in this cohort study were staged via BWH and AJCC 8 classifications and poor outcomes (ie, local recurrence [LR], nodal metastasis [NM], disease specific death [DSD], and overall survival [OS]) were compared. The study was carried out at a single academic tertiary care center in Boston, Massachusetts. MAIN OUTCOMES AND MEASURES Distinctiveness (outcome differences between tumor class), homogeneity (outcome similarity within tumor class), monotonicity (outcome worsening with increasing tumor class), and C statistic. RESULTS A total of 680 HNCSCCs in 459 patients were included in this study, of which 313 (68%) were men with the mean (SD) age of 70.2 (12.7) years. The AJCC 8 (T3/T4) and BWH (T2b/T3) high tumor classes accounted for 121 (18%) vs 63 (9%), 17 (71%) vs 16 (70%), and 11 (85%) vs 12 (92%) of total cases, metastases, and deaths, respectively. The AJCC 8 T2 and T3 comprised 23% of cases and had statistically indistinguishable outcomes. The BWH had higher specificity (93%) and positive predictive value (30%) for identifying cases at risk for metastasis or death. C statistics showed BWH to be superior in predicting NM and DSD (P = .01 and P = .005, respectively), but there was no difference for LR and OS. CONCLUSIONS AND RELEVANCE Lack of distinction between AJCC T2 and T3 resulted in a 23% subset of HNCSCCs with significant risk of metastasis and death-too large of a group for routine nodal staging or consideration of adjuvant therapy. The BWH identifies the same number of poor outcomes in a 9% subset of HNCSCCs, thus minimizing inappropriate upstaging of low-risk disease.

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Nodal staging of high-risk cutaneous squamous cell carcinoma

Abstract: It is reasonable to consider nodal staging for patients with HRcSCC (BWH stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, SLNB.

Cited by 37 publications

References 46 publications

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

Cutaneous Squamous Cell Carcinoma Tumour Size is Associated with Sentinel Lymph Node Metastasis in a Cohort of 69 Patients

Performance of the American Joint Committee on Cancer Staging Manual, 8th Edition vs the Brigham and Women’s Hospital Tumor Classification System for Cutaneous Squamous Cell Carcinoma

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