title: Metastatic Cutaneous Squamous Cell Carcinoma: The Importance of T2 Stratification and Hematologic Malignancy in Prognostication.
abstract: BACKGROUND
  While infrequent, nodal metastases in cutaneous squamous cell carcinoma (cSCC) can result in death from disease. Identification of those at risk for metastases is key to improved prognostication and treatment.
  
  
  OBJECTIVE
  To review metastatic cSCC at the study institution.
  
  
  METHODS
  Sixteen patients with metastatic cSCC were identified at the New York University Dermatologic Associates and Cancer Associates from 1998 to 2013. Patients were staged with American Joint Committee on Cancer (AJCC) and modified Brigham and Women's Hospital (BWH) criteria and compared to 32 control subjects.
  
  
  RESULTS
  Seven of 16 patients were identified as Stage T2 by AJCC criteria and Stage T2b by BWH criteria; two patients were on Stage T1, three patients were on more advanced T stages, and four patients lacked primary tumor data. Five patients had hematologic malignancy, and one patient had a solid-organ transplant.
  
  
  CONCLUSIONS
  The modified BWH criteria aims to better prognosticate the large group of T2 AJCC tumors, resulting in the majority of mortality. In the experience of the authors, the majority of patients with metastatic disease were on T2, stratifying to stage T2b by BWH criteria, or more advanced T stages. The findings of this study support BWH stratification of T2 tumors and also indicate that hematologic malignancy is a significant comorbidity associated with a poor outcome.
authors.affiliation: *The Ronald O. Perelman Department of Dermatology, New York University Langone Medical Center, New York, New York; †Laura and Isaac Perlmutter Cancer Center, New York University Langone Medical Center, New York, New York.
authors.forename: Mary L
authors.initials: ML
authors.lastname: Stevenson
authors.forename: Randie
authors.initials: R
authors.lastname: Kim
authors.forename: Shane A
authors.initials: SA
authors.lastname: Meehan
authors.forename: Anna C
authors.initials: AC
authors.lastname: Pavlick
authors.forename: John A
authors.initials: JA
authors.lastname: Carucci
mesh_terms: D002294:Carcinoma, Squamous Cell / Q000556:secondary*; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D016030:Kidney Transplantation; D015451:Leukemia, Lymphocytic, Chronic, B-Cell / Q000473:pathology; D008207:Lymphatic Metastasis; D018442:Lymphoma, B-Cell, Marginal Zone / Q000473:pathology; D016410:Lymphoma, T-Cell, Cutaneous / Q000473:pathology*; D008297:Male; D060787:Neoplasm Grading; D009361:Neoplasm Invasiveness; D009367:Neoplasm Staging; D009378:Neoplasms, Multiple Primary / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods; D012307:Risk Factors; D012878:Skin Neoplasms / Q000473:pathology*; D047368:Tumor Burden