While the majority of cutaneous squamous cell carcinomas (cSCCs) can be treated surgically, the additional work-up and treatments indicated for high-risk cSCC remain undefined. In recent years, improvements in tumor staging systems have allowed for the more accurate stratification of tumors into high- and low-risk categories. This insight, along with the publication of cSCC guidelines, brings us closer to the development of a consensus approach. The second article in this continuing medical education series addresses in question and answer format the most common questions related to advanced and high-stage cSCCs, with a simplified flowchart.
The questions include the following
- Does my patient have high-risk cSCC?
- What is the next step for patients with cSCC and palpable lymphadenopathy?
- In patients with no clinically evident lymphadenopathy, who are candidates for lymph node staging?
- What forms of radiologic imaging can help detect subclinical lymph node metastases?
- What is the role of sentinel lymph node biopsy in cSCC?
- Which patients with cSCC need adjuvant radiation therapy?
- Is adjuvant chemotherapy an option for patients with high-stage cSCC after surgery?
- Are targeted and immunologic therapies an option for advanced cSCC?
- How often should I follow up with my patient after he/she has been diagnosed with a high-risk cSCC?
- What are the options for chemoprophylaxis in a patient with an increased risk of cSCC?
- What chemopreventive measures can be started in coordination with medical oncology or transplant physicians?
Syril Keena T. Que, Fiona O. Zwald, Chrysalyne D. Schmults.
J Am Acad Dermatol. 2018, Volume 78, Issue 2, Pages 249–261