Prognostic Factors for Metastasis in Squamous Cell Carcinoma of the Skin

Abstract

background. Squamous cell carcinoma (SCC) of the skin exhibits a significant propensity to metastasize. A number of variables have been reported to influence the tendency of SCC to metastasize. Because of the increasing incidence of skin cancer, it is becoming increasingly important to identify those neoplasms which are biologically more aggressive. We report 25 cases of metastatic SCC and compare them to 175 cases of nonmetastasizing SCC treated during the same period. objective. To characterize tumors with the greatest tendency to metastasize. methods. A tumor registry from the Dermatologic Surgery Unit at the Medical University of South Carolina was accessed to obtain records on 200 patients diagnosed with invasive SCC managed by Mohs surgery from 1988 to 1998. A retrospective analysis was conducted. The characteristics of patients with metastatic SCC and those with nonmetastatic SCC were compared using the chi-squared test and Fisher's exact test. results. Of 200 tumors, 25 (12.5%) metastasized. Size, Clark's level, degree of differentiation, the presence of small tumor nests, infiltrative tumor strands, single-cell infiltration, perineural invasion, acantholysis, and recurrence all correlated strongly with metastasis. Location, ulceration, inflammation, and Breslow depth did not correlate with the development of metastasis. conclusion. Patients with tumors that exhibit certain clinical and histologic features are more likely to metastasize and need close follow-up to detect recurrence and metastasis early, allowing for appropriate life-saving intervention. Sentinel lymph node biopsy should be considered in patients with high-risk SCC.

Poor Outcomes in Head and Neck Non-Melanoma Cutaneous Carcinomas

“…Previous reports have quoted the incidence of metastases from cutaneous SCC between 0.5-16% [4] and BCC between 0.0028% to 0.5% [2]. The significantly higher incidence of metastatic and recurrent disease seen in our study reflects the referral pattern of our head and neck surgery practice, since patients referred to a head and neck surgeon at our institution have disease that is more likely already metastatic or recurrent.…”

“…Similarly, most of these lesions occur in the head and neck region. Unlike BCC, SCC has a greater propensity to metastasize with rates in the literature ranging from 0.5 to 16% [4]. Because most patients with NMCC never progress to developing metastatic or recurrent disease, the presence of either can be considered a poor outcome.…”

Significance of clinical stage, extent of surgery and outcome in cutaneous squamous cell carcinoma of the head and neck

“…There is no consensus on the indications for an elective neck dissection and extent of surgery, while further benefit can be expected from sentinel lymph node biopsy, selective neck dissection in high risk patients and adjuvant radiotherapy. 5,6,7 Only limited data exist on the relationship between clinical staging of advanced regional disease and patient survival rate. 8,9,10,11,12 The parotid gland is the first site for metastatic spread of head and neck CSCC, and parotid involvement poses a significant diagnostic and therapeutic challenge.…”

Fatores preditivos do maior número de estádios na cirurgia micrográfica de Mohs para o tratamento do carcinoma espinocelular da cabeça

“…As taxas de recidivas dos CECs operados pela CMM variaram de 2,3% a 10%, e as de metásta-ses variaram de 0,5% a 16%, segundo dados dos estudos de Rowe, Cherpelis e Osguthorpe. 6,23,24 Conforme o estudo de Rowe, ambas foram menores que as encontrads nas outras modalidades terapêuticas, que demonstraram recidivas de 3,7% a 47,2% e metástases de 5,2% a 47,3%. 6 Na análise estatística univariada dos fatores preditivos do número de estádios cirúrgicos na CMM apenas a condição de recidiva mostrou tendência a maior número de estádios (p = 0,08) (Tabela 4).…”