title: Uncertainty in the perioperative management of high-risk cutaneous squamous cell carcinoma among Mohs surgeons.
abstract: OBJECTIVE
  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).
  
  
  METHODS
  A survey study of randomly selected, fellowship-trained Mohs surgeons.
  
  
  METHODS
  An academic medical center.
  
  
  METHODS
  American College of Mohs Surgery members who responded to an e-mail invitation completed either a survey regarding management of HRCSCC (n=117) or SCC with perineural invasion (PNI) (n=118). Participants totaled approximately 25% of the American College of Mohs Surgery membership.
  
  
  METHODS
  (1) Percentage of patients with HRCSCC referred for RNS, sentinel lymph node biopsy (SLNB), or ART over the preceding 12 months; (2) top factors leading surgeons to consider RNS, SLNB, or ART; and (3) acceptance of ART for clinical scenarios of various degrees of PNI.
  
  
  RESULTS
  Most respondents cited PNI and in-transit metastasis as top factors leading to consideration of RNS, SLNB, or ART. Otherwise, there was no consensus regarding use of, or indications for, RNS, SLNB, or ART.
  
  
  CONCLUSIONS
  The lack of consistency between experts indicates that there is equipoise regarding indications for RNS and ART in HRCSCC. There is also wide variation in RNS and ART practices among Mohs surgeons who are specifically trained to manage HRCSCC. Clinical trials should therefore be conducted in these areas as there is no clear standard of care.
authors.affiliation: Department of Dermatology, University of Pennsylvania, Philadelphia, USA.
authors.forename: Anokhi
authors.initials: A
authors.lastname: Jambusaria-Pahlajani
authors.forename: Stephen D
authors.initials: SD
authors.lastname: Hess
authors.forename: Kenneth A
authors.initials: KA
authors.lastname: Katz
authors.forename: Daniel
authors.initials: D
authors.lastname: Berg
authors.forename: Chrysalyne D
authors.initials: CD
authors.lastname: Schmults
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000556:secondary / Q000601:surgery*; D003625:Data Collection; D006801:Humans; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness; D009364:Neoplasm Recurrence, Local; D010818:Practice Patterns, Physicians'; D018714:Radiotherapy, Adjuvant; D012017:Referral and Consultation; D012307:Risk Factors; D021701:Sentinel Lymph Node Biopsy; D012878:Skin Neoplasms / Q000473:pathology / Q000601:surgery*