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

Abstract

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.

Keywords: CR; CSCC; EGFR; HCSCC; SCC; SCCHN; VCSCC; carcinoma; cetuximab; complete response; cutaneous; cutaneous squamous cell carcinoma; epidermal growth factor receptor; high-risk cutaneous squamous cell carcinoma; radiation; skin; squamous; squamous cell carcinoma; squamous cell carcinoma of the head and neck; very high-risk cutaneous squamous cell carcinoma.