title: An evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma.
abstract: BACKGROUND
  No established standard of care exists for aggressive cutaneous squamous cell carcinoma (CSCC).
  
  
  OBJECTIVE
  We sought to establish an aggressive CSCC management protocol by reviewing high-risk CSCC (HCSCC) and very high-risk CSCC (VCSCC) cases at our institution.
  
  
  METHODS
  This was a retrospective review of all CSCC cases treated at our institution.
  
  
  RESULTS
  A total of 27 patients were identified of 1591 cases treated between 2000 and 2011. Four patients with HCSCC received surgery alone and 1 received surgery and radiation. All remain disease free (median follow-up 5 years). Among patients with VCSCC, 4 received surgery alone: 1 (25%) showing a complete response and 3 (75%) showing disease progression. Eleven received surgery and radiation: 4 (36.4%) with complete response (median follow-up 3 years) and 7 (63.6%) with disease progression (median time to recurrence 6 months). Six received surgery and cetuximab: 3 (50%) had a complete response (median follow-up 3 years), 2 (33%) had disease progression, and 1 (14%) could not be assessed because of inability to tolerate infusions. One patient received surgery, cetuximab, and radiation, and remains disease-free after 4 years.
  
  
  CONCLUSIONS
  Lack of randomization, blinding, a true control arm, or standardization of treatment protocols are limitations.
  
  
  CONCLUSIONS
  Patients with very HCSCC may have improved outcomes with surgery and adjuvant cetuximab.
authors.affiliation: Department of Dermatology, Division of Dermatologic Surgery, Columbia University Medical Center, New York, New York.
authors.forename: Kevin
authors.initials: K
authors.lastname: O'Bryan
authors.forename: William
authors.initials: W
authors.lastname: Sherman
authors.forename: George W
authors.initials: GW
authors.lastname: Niedt
authors.forename: Bret
authors.initials: B
authors.lastname: Taback
authors.forename: Spiros
authors.initials: S
authors.lastname: Manolidis
authors.forename: Antai
authors.initials: A
authors.lastname: Wang
authors.forename: Désirée
authors.initials: D
authors.lastname: Ratner
mesh_terms: D000328:Adult; D000368:Aged; D061067:Antibodies, Monoclonal, Humanized / Q000627:therapeutic use; D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D000068818:Cetuximab; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy; D006801:Humans; D007150:Immunohistochemistry; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D018714:Radiotherapy, Adjuvant; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy*; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D061067:Antibodies, Monoclonal, Humanized; D000068818:Cetuximab
keywords: CR; CSCC; EGFR; HCSCC; SCC; SCCHN; VCSCC; carcinoma; cetuximab; complete response; cutaneous; cutaneous squamous cell carcinoma; epidermal growth factor receptor; high-risk cutaneous squamous cell carcinoma; radiation; skin; squamous; squamous cell carcinoma; squamous cell carcinoma of the head and neck; very high-risk cutaneous squamous cell carcinoma