Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone.

BACKGROUND: There is little evidence to predict patient outcomes after the treatment of high-risk cutaneous SCC (hrSCC) using Mohs micrographic surgery (MMS). OBJECTIVE: We sought to report the rates of poor outcomes in patients with hrSCC treated by MMS alone and to determine if any specific clinical factors may be more predictive of these outcomes. METHODS: We conducted a retrospective chart review of all patients with hrSCC who were treated in our clinic between October 2011 and December 2015. RESULTS: We identified 647 hrSCC tumors that met the inclusion criteria. During the follow-up period, there were 19 local recurrences (2.9%), 31 nodal metastases (4.8%), 7 distant metastases (1.1%), and 7 disease-specific deaths (1.1%). Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death through multivariate analysis. CONCLUSIONS: Invasion beyond the subcutaneous fat and poor histologic differentiation may carry a greater risk of poor outcomes than other factors in hrSCC. MMS alone provides excellent marginal control with low rates of local recurrence, nodal metastasis, and disease-specific death.

Clinical and Pathologic Factors Predictive of Positive Radiologic Findings in High-Risk Cutaneous Squamous Cell Carcinoma.

BACKGROUND: At present, there exists considerable clinical uncertainty regarding the role of radiologic imaging in the staging and management of high-risk cutaneous squamous cell carcinoma (hrSCC). OBJECTIVE: The authors sought to investigate the clinical and pathologic features predictive of bony invasion, perineural invasion, or lymphadenopathy in patients that had undergone head and neck imaging for hrSCC. MATERIALS AND METHODS: The authors conducted a single-center retrospective chart review of patients (n = 82) that had undergone head and neck imaging for hrSCC. RESULTS: Twenty-nine percent (24/82) of patients in the study had positive findings on radiologic imaging. Immunocompromised patients were more likely to have the radiologic finding of lymphadenopathy (p = .04). Tumor size was found to correlate with the radiologic finding of bony invasion (correlation coefficient = 0.40, p = .0002). There was no relationship between either high risk location or high risk histopathology and positive radiologic findings. The low number of patients and its retrospective nature are study limitations. CONCLUSION: The clinical features of host immunosuppression and tumor size are predictive of positive imaging findings in hrSCC. The decision to perform radiologic imaging in patients with hrSCC may be influenced by these factors, but continue to be more firmly guided by physical exam and clinical suspicion.