title: Evaluation of the definitions of "high-risk" cutaneous squamous cell carcinoma using the american joint committee on cancer staging criteria and national comprehensive cancer network guidelines.
abstract: Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of "high-risk" cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify "high-risk" cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of "high-risk" tumors. We sought to evaluate the AJCC and NCCN definitions of "high-risk" cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (n = 211,82.1%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (≥2 cm); one tumor was "upstaged" due to "high-risk features." Using the NCCN taxonomy, 231 (87%) of tumors were "high-risk." Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of "high-risk" cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are "high-risk" by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of "high-risk" cSCC to optimize management.
authors.affiliation: Department of Dermatology, Saint Louis University, 1402 S. Grand Boulevard, 4th Floor, St. Louis, MO 63104, USA.
authors.forename: Melinda B
authors.initials: MB
authors.lastname: Chu
authors.affiliation: Stony Brook School of Medicine, Department of Dermatology, 181 N. Belle Mead Road, Suite 5, East Setauket, NY 11733, USA.
authors.forename: Jordan B
authors.initials: JB
authors.lastname: Slutsky
authors.affiliation: Department of Dermatology, Saint Louis University, 1402 S. Grand Boulevard, 4th Floor, St. Louis, MO 63104, USA.
authors.forename: Maulik M
authors.initials: MM
authors.lastname: Dhandha
authors.affiliation: School of Medicine, Saint Louis University, 1402 S. Grand Boulevard, St. Louis, MO 63104, USA.
authors.forename: Brandon T
authors.initials: BT
authors.lastname: Beal
authors.affiliation: Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, 4th Floor, St. Louis, MO 63110, USA.
authors.forename: Eric S
authors.initials: ES
authors.lastname: Armbrecht
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, 3635 Vista Avenue, St. Louis, MO 63110, USA.
authors.forename: Ronald J
authors.initials: RJ
authors.lastname: Walker
authors.affiliation: Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, 3635 Vista Avenue, St. Louis, MO 63110, USA.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Varvares
authors.affiliation: Department of Dermatology, Saint Louis University, 1402 S. Grand Boulevard, 4th Floor, St. Louis, MO 63104, USA.
authors.forename: Scott W
authors.initials: SW
authors.lastname: Fosko