Rates of Upstaging, Between Diagnosis and Surgery, and Clinical Management of Metastatic Cutaneous Squamous Cell Carcinoma: A Case–Control Study

Abstract

BACKGROUND Cutaneous squamous cell carcinomas (cSCC) have upstage rates of approximately 10.3% to 11.1%. Data are currently limited on the rate of upstaging for metastatic cSCC. OBJECTIVE The aim of this study was to determine the rates of upstaging, between diagnosis and surgery, and differences in management for metastatic and non-metastatic high-risk cSCC. MATERIALS AND METHODS This was a retrospective, case-control, single institution, multi-center study. Univariate analysis was used. RESULTS Sixty-eight subjects (34 metastatic & 34 non-metastatic) with 69 tumors were included. The overall rate of upstaging was 46.4%. The most common reasons for upstage were undocumented tumor size and under-diagnosis of poor differentiation. There were no differences in rates of upstaging. Preoperative imaging was performed in 43.6% of wide local excisions (WLE) versus 3.3% of Mohs micrographic surgery (MMS; p , .001). The median days from surgery to sentinel lymph node biopsy (SLNB), or nodal dissection was shorter for WLE versus MMS (0 vs 221 days, p , .001). CONCLUSION Improved clinical documentation, including documenting tumor size, and the identification of pathologic risk factors, including poor differentiation and depth of invasion, are needed for proper staging. Preoperative imaging and discussion of SLNB may be beneficial for high-risk T2b and T3 tumors.

Whole Exome and Transcriptome Sequencing of Stage-Matched, Outcome-Differentiated Cutaneous Squamous Cell Carcinoma Identifies Gene Expression Patterns Associated with Metastasis and Poor Outcomes

“…T2b tumors (4.7% of all cSCC) are considered high risk with a local recurrence rate of 21%, lymphatic metastasis in up to 30%, and disease-specific death in 10% [8]. Patients with T2b tumors and T3 have been defined as a group that may benefit from pre-operative imaging, a sentinel lymph node biopsy, and post-operative radiation [8, 9]. Progress in understanding altered genes in cancer has led to the identification of improved prognostic biomarkers [10].…”