A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma with Lymph Node Metastasis: Risk Factors and Clinical Course

Shera Feinstein, Shauna Higgins, Omeed Ahadiat, Ashley Wysong

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Abstract

BACKGROUNDThe single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).OBJECTIVETo characterize the risk factors for and clinical course of cutaneous SCC with NM.METHODSTen-year retrospective cohort study (2006-2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.RESULTSMost patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known "high-risk features" including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years.CONCLUSIONTo the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of "high-risk features" used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.

Original languageEnglish (US)
Pages (from-to)772-781
Number of pages10
JournalDermatologic Surgery
Volume45
Issue number6
DOIs
StatePublished - Jun 1 2019

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Squamous Cell Carcinoma
Cohort Studies
Retrospective Studies
Lymph Nodes
Neoplasm Metastasis
Skin
Neoplasms
Subcutaneous Fat
Tertiary Care Centers
Disease-Free Survival
Neck
Head
Mortality
Therapeutics

ASJC Scopus subject areas

  • Surgery
  • Dermatology

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A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma with Lymph Node Metastasis : Risk Factors and Clinical Course. / Feinstein, Shera; Higgins, Shauna; Ahadiat, Omeed; Wysong, Ashley.

In: Dermatologic Surgery, Vol. 45, No. 6, 01.06.2019, p. 772-781.

Research output: Contribution to journalArticle

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title = "A Retrospective Cohort Study of Cutaneous Squamous Cell Carcinoma with Lymph Node Metastasis: Risk Factors and Clinical Course",
abstract = "BACKGROUNDThe single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).OBJECTIVETo characterize the risk factors for and clinical course of cutaneous SCC with NM.METHODSTen-year retrospective cohort study (2006-2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.RESULTSMost patients were men (84.6{\%}, 44/52), and almost all primary tumors were on the head and neck (96.2{\%}, 51/53). Most primary tumors were characterized by known {"}high-risk features{"} including perineural invasion (56.6{\%}, 30/53), diameter ≥2 cm (54.7{\%}, 29/53), invasion beyond subcutaneous fat (43.4{\%}, 23/53), and poor differentiation (32.1{\%}, 17/53). In addition, many tumors were recurrent (52.8{\%}, 28/53), and many patients were immunosuppressed (30.8{\%}, 16/52). Disease-free survival after treatment of nodal disease was 7.5{\%} (4/53) at 5 years.CONCLUSIONTo the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of {"}high-risk features{"} used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.",
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AU - Wysong, Ashley

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N2 - BACKGROUNDThe single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).OBJECTIVETo characterize the risk factors for and clinical course of cutaneous SCC with NM.METHODSTen-year retrospective cohort study (2006-2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.RESULTSMost patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known "high-risk features" including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years.CONCLUSIONTo the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of "high-risk features" used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.

AB - BACKGROUNDThe single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM).OBJECTIVETo characterize the risk factors for and clinical course of cutaneous SCC with NM.METHODSTen-year retrospective cohort study (2006-2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM.RESULTSMost patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known "high-risk features" including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years.CONCLUSIONTo the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of "high-risk features" used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.

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