Surgical Pearls for High Risk Cutaneous Squamous Cell Carcinoma

In a presentation on surgical pearls for managing high-risk cutaneous squamous cell carcinoma (SCC), Dr. Justin Leitenberger discusses key practices and techniques essential for effective treatment. He emphasizes the advantages of peripheral and deep margin assessment (PDEMA) techniques, including Mohs micrographic surgery (MMS), over standard excision methods, highlighting significant reductions in local recurrence, nodal metastasis, and disease-specific mortality associated with MMS. He details surgical strategies, stressing the importance of complete tumor removal during the debulking process and the need for meticulous assessment of margins, particularly in high-risk cases. An illustrative case study on a renal transplant patient with recurrent poorly differentiated SCC illustrates challenges in achieving clear margins and the necessity for careful monitoring. Leitenberger also notes the implications of adjuvant radiation therapy, discussing how wound repair decisions can impact healing and surveillance post-surgery. His conclusions advocate for precise margin control through PDEMA, collaboration with pathologists for additional evaluation, and strategic planning for postoperative care to optimize outcomes in high-risk SCC patients.