Pretreatment for Cutaneous SCC
If there is any diagnostic uncertainty, histological confirmation of cutaneous squamous cell carcinoma (SCC) lesions should be obtained before planning definitive treatment.
Before performing any diagnostic or treatment procedure, the following should be recorded:
Maximum clinical cutaneous SCC lesion dimension (typically diameter, in mm)
The plane of the deep-excision margin
Whether the tumor is recurrent or whether it is in a field of previous radiotherapy
The immunocompetency of the patient
Treatment Options for Primary Cutaneous SCC
The first-line treatment that should be offered to people with resectable primary cutaneous SCC is surgical excision.
Determine peripheral tumor margins under bright lighting with magnification or with dermoscopy.
The following should be offered to patients with cutaneous SCC who have one or more involved margins or margins less than 1 mm, in whom patient or tumor factors suggest higher risk:
Wide local excision (delayed reconstruction likely)
Mohs micrographic surgery
Active treatment can be offered to immunosuppressed cutaneous SCC patients who have one or more clear-but-close (<1 mm) or involved margins, followed by structured follow-up and surveillance.
If patients have symptomatic perineural invasion or radiological evidence of perineural invasion, their case should be discussed by a specialist skin cancer multidisciplinary team.
Mohs micrographic surgery can also be considered in selected patients with cutaneous SCC after discussion by a specialist skin cancer multidisciplinary team; this particularly applies to cases in which tumor margins are difficult to delineate or in locations where tissue conservation is important for function.
Before considering radiotherapy in patients with histologically proven cutaneous SCC, discuss the case with a multidisciplinary team, to include either a local skin cancer multidisciplinary team or a specialist skin cancer multidisciplinary team, with a clinical oncologist present.
Curettage and cautery with curative intent can be considered in immunocompetent patients with low-risk, small (<1 cm), well-defined, nonrecurrent cutaneous SCC.
Locally Advanced, Recurrent, and Metastatic Cutaneous SCC
In patients with the following variables, an individualized specialist skin cancer multidisciplinary team should be involved, to include multimodality and imaging treatment plans:
Regional lymph node metastasis
Immunocompromise with locally advanced and/or metastatic cutaneous SCC
In-transit metastases from cutaneous SCC
Metastatic cutaneous SCC who have experienced further locoregional relapse following lymphadenectomy
Therapeutic regional lymphadenectomy should be offered to patients with head and neck cutaneous SCC with regional lymph node metastasis. It should also be offered to patients with non–head and neck cutaneous SCC who have regional lymph node metastases in axillary, inguinofemoral, or other peripheral draining nodes.
Adjuvant radiotherapy should be offered after therapeutic regional lymphadenectomy to patients with cutaneous SCC who have high-risk pathology.
Insufficient Evidence to Support Any Recommendation for Cutaneous SCC
The evidence is insufficient to support any recommendations for the following therapies in the treatment of cutaneous SCC:
Carbon dioxide laser therapy
For more information, please go to Cutaneous Squamous Cell Carcinoma.
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Any views expressed above are the author's own and do not necessarily reflect the views of WebMD or Medscape.
Cite this: Cutaneous Squamous Cell Carcinoma Clinical Practice Guidelines (BAD, 2021) - Medscape - Apr 06, 2021.