Cutaneous Squamous Cell Carcinoma Clinical Practice Guidelines (BAD, 2021)

British Association of Dermatologists

These are some of the highlights of the guidelines without analysis or commentary. For more information, go directly to the guidelines by clicking the link in the reference.

April 06, 2021

Guidelines on the management of cutaneous squamous cell carcinoma were published in March 2021 by the British Association of Dermatologists in the British Journal of Dermatology.[1]

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

  • Adjuvant radiotherapy

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:

  • Cryotherapy

  • Carbon dioxide laser therapy

  • Topical therapies

For more information, please go to Cutaneous Squamous Cell Carcinoma.


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