Management of High-Risk Squamous Cell Carcinoma of the Skin.
Non-melanoma skin cancer (NMSC) is the most common malignancy in the USA, with cutaneous squamous cell carcinomas (cSCCs) constituting approximately 20 % of all NMSC. While cSCCs typically behave in an indolent fashion and can be cured with local destructive or surgical methods, a small subset metastasizes and induces significant morbidity and mortality. Identifying and aggressively treating these "high-risk" cSCCs (HRcSCCs) is thus paramount. Recent improvements in staging cSCCs appear to offer better risk stratification than earlier staging criteria. Radiologic imaging and sentinel lymph node biopsy may be beneficial in certain cases of HRcSCC, although more studies are needed before these techniques should be uniformly incorporated into management. Surgery with complete margin control, such as that offered by the Mohs micrographic technique, represents the first-line treatment for these tumors. Radiation therapy is likely most beneficial in the adjuvant setting. Chemotherapy is typically best reserved for patients with metastatic or locally advance disease that is not controllable with surgical and/or radiation therapies. Newer targeted treatments, such as EGFR inhibitors and immunotherapies may offer greater efficacy in these settings, although further evaluation is needed.
Stanford University Medical Center Department of Dermatology, 450 Broadway, Pavilion C, 2nd Floor, MD-5334, Redwood City, CA, 94063, USA.
Teresa
T
Fu
Stanford University Medical Center Department of Dermatology, 450 Broadway, Pavilion C, 2nd Floor, MD-5334, Redwood City, CA, 94063, USA.
Sumaira Z
SZ
Aasi
Stanford University Medical Center Department of Dermatology, 450 Broadway, Pavilion C, 2nd Floor, MD-5334, Redwood City, CA, 94063, USA. shollm@stanford.edu.
S Tyler
ST
Hollmig
D000818:Animals; D001706:Biopsy; D002294:Carcinoma, Squamous Cell / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D019468:Disease Management; D005500:Follow-Up Studies; D006801:Humans; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D012878:Skin Neoplasms / Q000175:diagnosis* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D016896:Treatment Outcome
Chemotherapy; Cutaneous squamous cell carcinoma; Evaluation; High-risk squamous cell carcinoma; Imaging; Immunotherapy; Management; Mohs micrographic surgery; Sentinel lymph node biopsy; Surgery; Targeted therapy; Treatment; Workup