title: The positive impact of radiologic imaging on high-stage cutaneous squamous cell carcinoma management.
abstract: BACKGROUND
  There is limited evidence on the utility of radiologic imaging for prognostic staging of cutaneous squamous cell carcinoma (CSCC).
  
  
  OBJECTIVE
  Review utilization of radiologic imaging of high-stage CSCCs to evaluate whether imaging impacted management and outcomes.
  
  
  METHODS
  Tumors classified as Brigham and Women's Hospital (BWH) tumor (T) stage T2B or T3 over a 13-year period were reviewed to identify whether imaging was performed and whether results affected treatment. Disease-related outcomes (DRO: local recurrence, nodal metastasis, death from disease) were compared between patients by type of imaging used.
  
  
  RESULTS
  108 high-stage CSCCs in 98 patients were included. Imaging (mostly computed tomography, 79%) was utilized in 45 (46%) patients and management was altered in 16 (33%) patients who underwent imaging. Patients that received no imaging were at higher risk of developing nodal metastases (nonimaging, 30%; imaging, 13%; P = .041) and any DRO (nonimaging, 42%; imaging, 20%; P = .028) compared to the imaging group. Imaging was associated with a lower risk for DRO (subhazard ratio, 0.5; 95% CI 0.2-0.9; P = .046) adjusted for BWH T stage, sex, and location.
  
  
  CONCLUSIONS
  Single institution retrospective design and changes in technology overtime.
  
  
  CONCLUSIONS
  Radiologic imaging of high-stage CSCC may influence management and appears to positively impact outcomes. Further prospective studies are needed to establish which patients benefit from imaging.
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Emily Stamell
authors.initials: ES
authors.lastname: Ruiz
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Pritesh S
authors.initials: PS
authors.lastname: Karia
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.
authors.forename: Frederick C
authors.initials: FC
authors.lastname: Morgan
authors.affiliation: Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address: cschmults@partners.org.
authors.forename: Chrysalyne D
authors.initials: CD
authors.lastname: Schmults
mesh_terms: D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000000981:diagnostic imaging* / Q000473:pathology; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D009367:Neoplasm Staging; D000072078:Positron Emission Tomography Computed Tomography; D012189:Retrospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology; D014057:Tomography, X-Ray Computed
keywords: cutaneous squamous cell carcinoma; disease-related outcomes; nodal metastasis; prognosis; radiologic imaging; squamous cell carcinoma imaging; staging