An evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma

Kevin O'Bryan, William Sherman, George W Niedt, Bret Taback, Spiros Manolidis, Antai Wang, Désirée Ratner
Journal of the American Academy of Dermatology 2013, 69 (4): 595-602.e1

BACKGROUND: No established standard of care exists for aggressive cutaneous squamous cell carcinoma (CSCC).

OBJECTIVE: We sought to establish an aggressive CSCC management protocol by reviewing high-risk CSCC (HCSCC) and very high-risk CSCC (VCSCC) cases at our institution.

METHODS: This was a retrospective review of all CSCC cases treated at our institution.

RESULTS: A total of 27 patients were identified of 1591 cases treated between 2000 and 2011. Four patients with HCSCC received surgery alone and 1 received surgery and radiation. All remain disease free (median follow-up 5 years). Among patients with VCSCC, 4 received surgery alone: 1 (25%) showing a complete response and 3 (75%) showing disease progression. Eleven received surgery and radiation: 4 (36.4%) with complete response (median follow-up 3 years) and 7 (63.6%) with disease progression (median time to recurrence 6 months). Six received surgery and cetuximab: 3 (50%) had a complete response (median follow-up 3 years), 2 (33%) had disease progression, and 1 (14%) could not be assessed because of inability to tolerate infusions. One patient received surgery, cetuximab, and radiation, and remains disease-free after 4 years.

LIMITATIONS: Lack of randomization, blinding, a true control arm, or standardization of treatment protocols are limitations.

CONCLUSIONS: Patients with very HCSCC may have improved outcomes with surgery and adjuvant cetuximab.

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