title: Mortality risk from squamous cell skin cancer.
abstract: OBJECTIVE
  To identify nonmelanoma skin cancer patients with squamous cell carcinoma (SCC) who are at greatest risk of disease-specific mortality.
  
  
  METHODS
  Prospectively enrolled patients with a minimum of one pathologically confirmed skin SCC lesion, definitive treatment of the SCC lesion(s) resulting in no evidence of disease, and at least 2 months of follow-up after definitive treatment were eligible for the present longitudinal analysis. They received comprehensive clinical, pathologic evaluations and follow-up for patterns of failure and mortality.
  
  
  RESULTS
  We enrolled 210 patients (187 men and 23 women) with a total of 277 skin SCC lesions and a median enrollment age of 68 years (range, 34 to 95 years). Median follow-up of surviving patients was 22 months. Three-year overall and disease-specific survival (DSS) rates were 70% and 85%, respectively. In univariate analyses, the clinical-pathologic factors associated with adverse DSS were local recurrence at presentation (P = .05), invasion beyond subcutaneous tissues (P = .009), perineural invasion (P = .002), lesion size (P = .0003), and depth of invasion (P = .05). Statistical models identified a homogeneous high-risk group of patients with lesions > or = 4 cm, perineural invasion, and deep invasion beyond subcutaneous structures. Three-year DSS was 100% for patients with no risk factors versus 70% for patients with at least one risk factor.
  
  
  CONCLUSIONS
  Lesion size > or = 4 cm and histologic evidence of perineural invasion and deep invasion beyond subcutaneous structures were the clinical-pathologic factors most significantly associated with disease-specific mortality in skin SCC.
authors.affiliation: Department of Head and Neck Surgery, The University of Texas M.D. Anderson Cancer Center, Houston, TX 77030-4009, USA. gclayman@mdanderson.org
authors.forename: Gary L
authors.initials: GL
authors.lastname: Clayman
authors.forename: J Jack
authors.initials: JJ
authors.lastname: Lee
authors.forename: F Christopher
authors.initials: FC
authors.lastname: Holsinger
authors.forename: Xian
authors.initials: X
authors.lastname: Zhou
authors.forename: Madeleine
authors.initials: M
authors.lastname: Duvic
authors.forename: Adel K
authors.initials: AK
authors.lastname: El-Naggar
authors.forename: Victor G
authors.initials: VG
authors.lastname: Prieto
authors.forename: Evelyn
authors.initials: E
authors.lastname: Altamirano
authors.forename: Susan L
authors.initials: SL
authors.lastname: Tucker
authors.forename: Sara S
authors.initials: SS
authors.lastname: Strom
authors.forename: Margaret L
authors.initials: ML
authors.lastname: Kripke
authors.forename: Scott M
authors.initials: SM
authors.lastname: Lippman
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000401:mortality* / Q000473:pathology