title: Squamous cell carcinoma with aggressive subclinical extension: 5-year retrospective review of diagnostic predictors.
abstract: BACKGROUND
  Squamous cell carcinoma with aggressive subclinical extension (SCC-ASE) is a tumor whose extensive spread becomes revealed during surgery or pathologic review, particularly during Mohs micrographic surgery. Limited clinical awareness of these lesions may result in unanticipated longer surgical times and larger postoperative defects. SCC-ASE-associated clinical risk factors are not well studied.
  
  
  OBJECTIVE
  We sought to evaluate the incidence of and risk factors associated with SCC-ASE.
  
  
  METHODS
  We conducted a retrospective analysis of SCC treated with Mohs micrographic surgery between 2007 and 2012 at a single academic surgical center. SCC-ASE was defined as a lesion requiring at least 3 Mohs stages with a final surgical margin of ≥1 cm.
  
  
  RESULTS
  Of 954 cases studied, 31% were SCC-ASE. In multivariable analysis, sex (P = .001), history of previous nonmelanoma skin cancer (P < .001), Fitzpatrick skin types II and III (P = .004 and <.001, respectively), immunosuppression related to solid organ transplant (P < .001), and cigarette use (P < .001) were significant predictors of SCC-ASE.
  
  
  CONCLUSIONS
  Single academic center selection bias, not-controlled for sun exposure differences, no information on medication regimens of solid organ transplant patients, and a small sample size are all limitations of our study.
  
  
  CONCLUSIONS
  Easily attainable demographic factors, especially immunosuppressed status and cigarette use, can help predict the occurrence of SCC-ASE and thereby optimize surgical planning and patient preparedness.
authors.affiliation: University of California, San Diego School of Medicine, La Jolla, California. Electronic address: a1golden@ucsd.edu.
authors.forename: Alina
authors.initials: A
authors.lastname: Goldenberg
authors.affiliation: Division of Dermatology, University of California, San Diego, La Jolla, California.
authors.forename: Arisa
authors.initials: A
authors.lastname: Ortiz
authors.affiliation: North Shore Medical Center, Salem, Massachusetts.
authors.forename: Silvia S
authors.initials: SS
authors.lastname: Kim
authors.affiliation: Division of Dermatology, University of California, San Diego, La Jolla, California.
authors.forename: S Brian
authors.initials: SB
authors.lastname: Jiang
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology*; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D009361:Neoplasm Invasiveness; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D013997:Time Factors
keywords: Mohs; aggressive; cigarette; immunosuppression; smoking; squamous cell carcinoma; subclinical
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