title: Review of high-risk features of cutaneous squamous cell carcinoma and discrepancies between the American Joint Committee on Cancer and NCCN Clinical Practice Guidelines In Oncology.
abstract: Cutaneous squamous cell carcinoma (SCC) is a malignancy that arises from epidermal keratinocytes. Although the majority of cutaneous SCC cases are easily treated without further complication, some behave more aggressively and carry a poor prognosis. These "high-risk" cutaneous SCCs commonly originate in the head and neck and have an increased tendency toward recurrence, local invasion, and distant metastasis. Factors for high-risk cutaneous SCC include large size (>2 cm), a deeply invasive lesion (>2 mm), incomplete excision, high-grade/desmoplastic lesions, perineural invasion (PNI), lymphovascular invasion, immunosuppression, and high-risk anatomic locations. Both the National Comprehensive Cancer Network®(NCCN®) and the American Joint Committee on Cancer (AJCC) identify several of these high-risk features of cutaneous SCC. The purpose of this article was to review the high-risk features included in these guidelines, as well as their notable discrepancies and omissions. We also provide a brief overview of current prophylactic measures, surgical options, and adjuvant therapies for high-risk cutaneous SCC. © 2016 Wiley Periodicals, Inc. Head Neck 39: 578-594, 2017.
authors.affiliation: Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Samuel Lamarre
authors.initials: SL
authors.lastname: Skulsky
authors.affiliation: Department of Plastic and Reconstructive Surgery, Beaumont Hospital, Dublin, Ireland.
authors.forename: Barry
authors.initials: B
authors.lastname: O'Sullivan
authors.affiliation: St. Luke's Radiation Oncology Network, Beaumont Hospital, Dublin, Ireland.
authors.forename: Orla
authors.initials: O
authors.lastname: McArdle
authors.affiliation: Department of Pathology, Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Mary
authors.initials: M
authors.lastname: Leader
authors.affiliation: Department of Dermatology, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Muireann
authors.initials: M
authors.lastname: Roche
authors.affiliation: Department of Nephrology and Renal Transplantation, Beaumont Hospital and Royal College of Surgeons in Ireland, Dublin, Ireland.
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Conlon
authors.affiliation: Department of Neurosciences, Otolaryngology and Cochlear Implant, Royal College of Surgeons in Ireland, Beaumont Hospital, Dublin, Ireland.
authors.forename: James Paul
authors.initials: JP
authors.lastname: O'Neill
mesh_terms: D001707:Biopsy, Needle; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D007150:Immunohistochemistry; D008297:Male; D008495:Medical Oncology / Q000592:standards*; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D017410:Practice Guidelines as Topic; D011379:Prognosis; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000401:mortality / Q000473:pathology* / Q000628:therapy; D012955:Societies, Medical; D016019:Survival Analysis; D016896:Treatment Outcome; D014481:United States
keywords: American Joint Committee on Cancer (AJCC); National Comprehensive Cancer Network (NCCN); cutaneous squamous cell carcinoma (SCC); deep margin; immunosuppression; parotid; sentinel lymph node biopsy