Setting the stage: Contemporary staging of non-melanomatous skin cancer and implementation of the new American Joint Committee on cancer eighth edition staging manual

40-Gene Expression Profile Representative of Metastatic Risk of Squamous Cell Carcinoma in a Mohs Surgical Patient

“…Our case highlights a discrepancy in current staging techniques and the results of 40-GEP testing. In this case, our patient had an AJCC8 staging was T3 (stage T2: tumor > 2 cm, but ≤ 4 cm in diameter, stage T3: tumor > 4 cm in diameter or minor bone erosion, perineural invasion or deep invasion) [2], and BWH staging was a T2B (staging that included two to three risk factors: > 2 cm lesion, poorly differentiated histology, and tumor invasion beyond the subcutaneous fat) [3]; however, his 40-GEP staging was Class 1 (low risk) < 7% risk of metastasis within three years [4][5][6]. This method uses a molecular algorithm of the gene expression profile of cutaneous SCCs with known outcomes [4][5][6].…”

“…As of now, there are several staging and categorization types used to predict the best course of action for curative procedural interventions. These methods include appropriate use criteria (AUC) for Mohs surgery [1], the American Joint Committee for Cancer eighth edition (AJCC8) staging manual [2], and the Brigham and Women's Hospital (BWH) staging for cutaneous squamous cell carcinoma (SCC) [3]. The AUC is broken into zones and specific rules that guide when to use Mohs surgery for intervention.…”

“…SCC is appropriate to treat in zones H and M, whereas the L-zone requires size criteria, immunocompromised state, recurrence, aggressive tumor type, or other unique characteristics to be met [1]. Cutaneous skin cancers, such as SCCs, carry a known metastatic risk to patients, which can lead to morbidity and mortality [2][3][4]. Metastasis can be difficult to detect, but early metastasis detection can improve patient survival due to the early implication of suitable treatment [4].…”