Uncertainty in the Perioperative Management of High-Risk Cutaneous Squamous Cell Carcinoma Among Mohs Surgeons

Abstract

To evaluate whether Mohs surgeons' management of high-risk cutaneous squamous cell carcinoma (HRCSCC) is uniform regarding radiologic nodal staging (RNS) and adjuvant radiation therapy (ART).

Treatment Recommendations among Radiation Oncologists in the Treatment of Cutaneous Squamous Cell Carcinoma with Perineural Invasion

“…These results are strikingly similar to a study by Jambusaria-Pahalajani et al who evaluated the patterns of practice among fellowship trained Mohs surgeons through a survey [25]. They demonstrated a parallel lack of consensus regarding the indications for PORT in cases of mPNI.…”

“…While the response rates appear better in these studies, this does not increase their statistical power, which is based on the absolute number of analyzable responses. The number of completed responses in our survey (n = 352) compare well with the survey of Mohs surgeons (n = 118), although their response rate is higher at 47% due the fewer invited participants [25]. Given that the American Board of Radiology reported 3943 full-time equivalent ROs in 2010 [43], and approximately 9.5% of ROs specialize in head and neck cancers [28], this survey was successful in garnering treatment recommendations from an estimated 60% of all ROs specializing in head and neck cancers.…”

“…In fact, 184 ROs responded that they lack the expertise/experience with CSCC with PNI to participate in this survey. Surveys that target practitioners with a special interest in a particular topic tend to receive a higher response rate [25] [42]. While the response rates appear better in these studies, this does not increase their statistical power, which is based on the absolute number of analyzable responses.…”

“…Although the prognosis of cPNI is poor, radiotherapy is effective in providing symptom control, and may improve survival for some patients [19] [21]- [24]. Cases of cPNI are usually referred for radiotherapy [25]. On the other hand, it is likely that not all cases of mPNI require post-operative radiotherapy (PORT) as many are cured with surgery alone [26].…”

“…Mohs surgeons that demonstrated a great variability in the management of CSCC with PNI, including indications for radiotherapy referral [25]. The treatment recommendations among Radiation Oncologists (ROs) in the management of CSCC with PNI are unknown.…”