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Risk for Metastasis and Death from Cutaneous Squamous Cell Carcinoma

Summary and Comment |
July 3, 2013

Risk for Metastasis and Death from Cutaneous Squamous Cell Carcinoma

  1. Murad Alam, MD, MSCIAU1931

Updating specifics of the low but significant risks for disease-specific metastasis and death

  1. Murad Alam, MD, MSCIAU1931

The authors of a 10-year retrospective cohort study of cutaneous squamous cell carcinoma (cSCC) treated at Brigham and Women's Hospital in Boston reviewed 985 patients and 1982 tumors to identify risk factors independently associated with poor outcomes.

In a median follow-up of 50 months, these patients had a 2.1% risk for disease-specific death and a 3.7% risk for metastasis. Risk factors associated with elevated risk included tumor diameter >2 cm, invasion into fat, perineural invasion, poor histologic differentiation, and location on the ear, temple, or anogenital area. The size of the cohort precluded separate computation of the risk for poor outcomes in immunosuppressed or transplant patients. Similarly, tumor depth could not be evaluated as a risk factor, as this feature was not routinely reported by pathologists.

Comment

Although this retrospective, single-center study is not population-based, it makes a significant contribution. Until now, much of the data regarding risk factors for poor outcomes after cutaneous squamous cell carcinoma were not only very dated but also possibly no longer accurate, given changes in patient presentation and treatment strategies over time. These authors provide more-current data. The results show that cSCC is a serious disease with a nontrivial risk of mortality. Until we get a multicenter cohort study or a national registry, this may be some of the best information available to guide us in counseling patients and monitoring those at exceptionally high risk for progression.

  • Disclosures for Murad Alam, MD, MSCI at time of publication Grant / research support Medicis; OptMed; Valeant Editorial boards Archives of Dermatology; Dermatologic Surgery; Journal of Cosmetic Dermatology; Lasers in Medical Science; Skin Therapy Letter Leadership positions in professional societies American Academy Of Dermatology (Chair, Health Care Finance Committee); American College of Mohs Surgery (Board of Directors); American Society for Dermatologic Surgery (Board of Directors); American Society for Lasers in Medicine and Surgery (Chair, Scientific Program)

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