AAD
Author: Willhemenia Loremipsum Special session: Lorem ipsum dolor sit amet Category: Lorem ipsum View all results

Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.

  • Presentation

Surgical Management of High-Risk cSCC

Description

The presentation discusses the surgical management of high-risk cutaneous squamous cell carcinoma (cSCC), emphasizing evidence-based guidelines and surgical techniques including Mohs surgery. The speaker presents case studies that illustrate the complexities of treating high-risk cSCCs, covering preoperative imaging, surgical strategies, and postoperative management. Key points include the importance of comprehensive margin assessment, with Mohs surgery recommended for high-risk tumors to ensure better outcomes. The presentation outlines the necessity of appropriate staging through imaging, specifically highlighting when to utilize MRI and CT scans for effective treatment planning. Clinical surveillance protocols post-treatment are defined, tailored to varying degrees of risk, with regular follow-ups and patient education emphasized. The speaker also communicates the challenges faced by immunocompromised patients and the need for multidisciplinary teams to address complex cases of aggressive tumors. The conclusion underscores critical considerations for surgical approaches, the potential use of immunohistochemistry in enhancing margin assessments, and the holistic management of high-risk patients to optimize treatment outcomes.

View more

Conclusions

  • Surgical management with comprehensive margin assessment is the standard of care for high-risk cutaneous squamous cell carcinoma (cSCC).
  • Mohs surgery demonstrates excellent outcomes with low local recurrence rates and overall disease-specific survival rates.
  • Tumors with perineural invasion (PNI) have a significantly increased risk of recurrence if standard marginal assessments are used instead of more comprehensive approaches like Mohs.
  • Regular imaging and clinical surveillance can greatly improve outcomes for high-risk cSCC patients, particularly those with advanced disease stages.
  • For very high-risk tumors, considering a multidisciplinary approach for treatment decisions is crucial, especially when managing complex cases.
  • Immunosuppressed patients are at heightened risk of more aggressive and recurrent forms of cSCC, necessitating tailored treatment strategies.
  • Utilization of cytokeratin immunohistochemistry can enhance margin assessment during Mohs surgery for high-risk cases.
  • Sentinel lymph node biopsies (SLNB) may be beneficial for very high-risk cSCC but are currently associated with variable positive rates, necessitating more research to standardize their use.
  • Follow-up protocols recommend frequent clinical and imaging assessments for high-risk patients to catch potential recurrences early.
  • Soleymani T, Brodland DG, Arzeno J, Sharon DJ, Zitelli JA. Clinical outcomes of high-risk cutaneous squamous cell carcinomas treated with Mohs surgery alone: An analysis of local recurrence, regional nodal metastases, progression-free survival, and disease-specific death. J Am Acad Dermatol. 2023 Jan;88(1):109-117.
  • Fraga SD, Besaw RJ, Murad F, Schmults CD, Waldman A. Complete Margin Assessment Versus Sectional Assessment in Surgically Excised High-Risk Keratinocyte Carcinomas: A Systematic Review and Meta-Analysis. Dermatol Surg. 2022 Jul 1;48(7):704-710.
  • Xiong DD, Beal BT, Varra V, Rodriguez M, Cundall H, Woody NM, Vidimos AT, Koyfman SA, Knackstedt TJ. Outcomes in intermediate-risk squamous cell carcinomas treated with Mohs micrographic surgery compared with wide local excision. J Am Acad Dermatol. 2020 May;82(5):1195-1204. doi: 10.1016/j.jaad.2019.12.049. Epub 2019 Dec 27. PMID: 31887322.
  • Ruiz ES, Karia PS, Morgan FC, Schmults CD. The positive impact of radiologic imaging on high-stage cutaneous squamous cell carcinoma management. J Am Acad Dermatol. 2017 Feb;76(2):217-225. doi: 10.1016/j.jaad.2016.08.051.
  • Tokez S, Koekelkoren FHJ, Baatenburg de Jong RJ, Grünhagen DJ, Mooyaart AL, Nijsten T, van der Lugt A, Wakkee M. Assessment of the Diagnostic Accuracy of Baseline Clinical Examination and Ultrasonographic Imaging for the Detection of Lymph Node Metastasis in Patients With High-risk Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Dermatol. 2022 Feb;158(2):151-159.
  • Gupta N, Weitzman RE, Murad F, Koyfman SA, Smile TD, Chang MS, Maher JM, Schmults CD, Vidimos AT, Ruiz ES. Identifying Brigham and Women's Hospital stage T2a cutaneous squamous cell carcinomas at risk of poor outcomes. J Am Acad Dermatol. 2022 Jun;86(6):1301-1308.
  • Pride RLD, Lopez JJ, Brewer JD, Price DL, Otley CC, Roenigk RK, Arpey CJ, Baum CL. Outcomes of Sentinel Lymph Node Biopsy for Primary Cutaneous Squamous Cell Carcinoma of the Head and Neck. Dermatol Surg. 2022 Feb 1;48(2):157-161.