title: Comparison of the American Joint Committee on Cancer Seventh Edition and Brigham and Women's Hospital Cutaneous Squamous Cell Carcinoma Tumor Staging in Immunosuppressed Patients.
abstract: BACKGROUND
  The American Joint Committee on Cancer 7th edition (AJCC-7) and Brigham and Women's Hospital (BWH) staging criteria for cutaneous squamous cell carcinoma (cSCC) have not been validated in immunosuppressed patients.
  
  
  OBJECTIVE
  To compare the AJCC-7 and BWH staging systems for cSCCs in immunosuppressed patients.
  
  
  METHODS
  A single-institution retrospective cohort study of cSCCs in immunosuppressed patients. Risks of local recurrence (LR), nodal metastasis (NM), in-transit metastasis, and any poor outcome (PO) were compared among AJCC-7 and BWH tumor T stages.
  
  
  RESULTS
  One hundred six patients had 412 primary invasive cSCCs. Eighty-five percent were AJCC-7 T1, and 15% T2. Risks of NM and PO for AJCC-7 T1 versus T2 were 0.9% versus 5% and 12.8% versus 23.3%, respectively, p < .05. Eighty-one percent of tumors were BWH T1, 18% T2a, 1% T2b, and 0.2% T3. Risk of LR for BWH T1 versus T2a was 11.4% versus 20.3%, p < .01. Risk of NM increased from 0.3% for T1 to 4.1%, 25%, and 100% for T2a, T2b, and T3, p < .05. Ninety percent of PO occurred in low-stage BWH T1/T2a.
  
  
  CONCLUSIONS
  Low T-stage cSCCs account for most POs. Brigham and Women's Hospital staging criteria better risk stratifies cSCCs in immunosuppressed patients for risk of NM and LR.
authors.affiliation: *Department of Dermatology, Tufts Medical Center, Boston, Massachusetts; †Tufts University School of Medicine, Boston, Massachusetts.
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Gonzalez
authors.forename: Kiera
authors.initials: K
authors.lastname: Cunningham
authors.forename: Rebecca
authors.initials: R
authors.lastname: Silverman
authors.forename: Elena
authors.initials: E
authors.lastname: Madan
authors.forename: Bichchau M
authors.initials: BM
authors.lastname: Nguyen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000453:epidemiology / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007165:Immunosuppression Therapy; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000592:standards*; D012189:Retrospective Studies; D018570:Risk Assessment; D012878:Skin Neoplasms / Q000453:epidemiology / Q000473:pathology*; D014481:United States