High Risk Squamous Cell Carcinoma
Important high-risk features in cutaneous squamous cell carcinoma (cSCC) include poor differentiation, perineural invasion, tumour size ≥20 mm, location on high-risk areas (e.g., ears, lips), and rapid growth. These features with poor prognostic indicators necessitate more aggressive management strategies to optimise patient outcomes.
Diagnostic techniques like biopsy, histopathology, and imaging modalities (e.g., MRI, CT) to accurately stage the disease, is critical for deciding the extent of treatment. Even sentinel lymph node biopsy is indicated for staging in certain cases.
Based on risk assessment, treatment recommendations include: surgical excision with adequate margins, Mohs micrographic surgery for high-risk locations or recurrent tumours, adjuvant radiotherapy for high-risk features or incomplete excision, and systemic therapies (immunotherapy and targeted therapies) for advanced, metastatic, or inoperable cases.
Regular follow-ups to monitor for recurrence or new primary tumours are important in patients with high-risk cSCC.
Stanganelli, I., Spagnolo, F., Argenziano, G., et al. (2022). "The Multidisciplinary Management of Cutaneous Squamous Cell Carcinoma: A Comprehensive Review and Clinical Recommendations by a Panel of Experts." Cancers, 14(2), 377. doi:10.3390/cancers14020377