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- Presentation
High-Risk Cutaneous Squamous Cell Carcinoma: Cases from Connecticut
Description
The session focused on the management of high-risk cutaneous squamous cell carcinoma (SCC) through case-based discussions led by Katie Swozi and a panel of experts. The importance of accurate staging was emphasized as only 3-5% of patients experience local recurrence or disease-specific death despite favorable overall prognoses. A case involving a 72-year-old man revealed complexities in staging due to depth of invasion and recurrence, highlighting discrepancies between AJCC and alternative staging systems. NCCN guidelines were reviewed, considering tumor type and patient factors, notably immunosuppressed status, which places a patient at a higher risk. Another case presented a 63-year-old lung transplant recipient with multiple SCCs, which progressed rapidly despite surgical interventions and adjustments to immunosuppressive therapy. This case underscored the challenges faced in managing SCC in transplant patients, particularly concerning high rates of recurrence and metastasis. The need for a multidisciplinary approach to treatment, including potential neoadjuvant immunotherapy, surgical options, and ongoing monitoring, was discussed. The panel concluded by acknowledging the limited data available for optimal management strategies, especially in high-risk populations, illustrating the ongoing challenges in dermatological oncology.
View moreConclusions
- Accurate staging of cutaneous squamous cell carcinoma (cSCC) is critical for predicting outcomes such as local recurrence and disease-specific death.
- Using AJCC 8 criteria, cSCC tumors classified as T3 have a higher likelihood of poor outcomes compared to T2 tumors under AJCC 7.
- High-risk features in cSCC include deep invasion beyond subcutaneous fat, perineural invasion, and poorly differentiated histology.
- NCCN guidelines include patient factors such as immunosuppression and tumor growth rate in management decisions for high-risk cSCC cases.
- Immunosuppressed patients are at a significantly higher risk for developing multiple cSCCs and require more vigilant monitoring and management.
- After neoadjuvant therapy with agents like pembrolizumab, surgical options must be reconsidered based on clinical response and recurrence risks.
- The management of satellites or in-transit metastases in recurrent cSCC necessitates multidisciplinary discussions for optimal treatment strategies.
- Future efforts will focus on improving data and outcomes for high-risk cSCC through enhanced staging and treatment protocols.
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- 1. Mager et al. Clin Cosmet Investig Dermatol. 2023
- 2. Gross et al. NEJM. 2022
- American Joint Committee on Cancer (AJCC) TNM Staging Classification for Cutaneous Carcinoma of the Head and Neck (8th ed ., 2017)