Efficacy and recurrence rate seem to favor EVLT, whereas postoperative pain and bruising favor RFA. Further studies are needed to validate the significance of the differences found.

The concept of the sentinel lymph node biopsy (SLNB) has been universally accepted for melanoma, however, remains controversial for squamous cell carcinoma (SCC). We performed a quantitative review on 260 cases of SCC that had a SLNB. The positivity rate was found to be 14.6%. Literature was qualitatively reviewed to determine whether a positive SLNB has any bearing on prognosis in SCC cases, finding a significant relationship between poor prognosis and a positive SLN (P = 0.0082).

BACKGROUND The single most important prognostic indicator for mortality in patients with cutaneous squamous cell carcinoma (SCC) is the development of nodal metastasis (NM). OBJECTIVE To characterize the risk factors for and clinical course of cutaneous SCC with NM. METHODS Ten-year retrospective cohort study (2006–2017) at an academic tertiary care center reviewing 53 cutaneous SCC tumors with NM. RESULTS Most patients were men (84.6%, 44/52), and almost all primary tumors were on the head and neck (96.2%, 51/53). Most primary tumors were characterized by known “high-risk features” including perineural invasion (56.6%, 30/53), diameter ≥2 cm (54.7%, 29/53), invasion beyond subcutaneous fat (43.4%, 23/53), and poor differentiation (32.1%, 17/53). In addition, many tumors were recurrent (52.8%, 28/53), and many patients were immunosuppressed (30.8%, 16/52). Disease-free survival after treatment of nodal disease was 7.5% (4/53) at 5 years. CONCLUSION To the best of the authors' knowledge, this study is the largest retrospective cohort of cutaneous SCC with NM to date. The results verify the significance of “high-risk features” used by current staging systems while highlighting additional features that may have prognostic value. This study may be used to refine current staging systems, improve early detection, and optimize management for these aggressive tumors.

With recent changes in staging of cutaneous squamous cell carcinoma (SSC), we examine the underuse of the sentinel lymph node biopsy (SLNB) in the management of high-risk SCC. To date, the most important determinant of mortality in SCC is the presence of lymph node metastasis. 1 Recent data have led to an updated staging system for cutaneous SCC proposed by Brigham and Women's Hospital, which emphasizes the presence or absence of high-risk features. This new staging system stratified T staging of SCC tumors based on the number of high-risk features present (>2-cm diameter, poor differentiation, perineural invasion, extension beyond subcutaneous fat). T1 tumors have no high-risk features, whereas T2a tumors have 1, T2b have 2 to 3, and T3 have all 4 or bone invasion. In a validation study by Schmitt et al, 2 tumors with 2 or 3 high-risk features had an SLNB positivity rate of 29%, whereas tumors with all 4 risk features had lymph node metastasis rate of 50%. The reported positivity rate of SLNB in the setting of high-risk SCC in the literature is 12% to 44%. 3 The National Comprehensive Cancer Network guidelines recommend discussing and offering SLNB to patients with melanoma skin cancers of stages 1B and up. 4 The SLNB positivity rate for stage 1B tumors is 7% to 10%, which is lower than that of high-risk SCC tumors. 5Methods | We created a database of all high-risk patients with SCC treated at the University of Southern California, including the Keck Medical Center and Los Angeles County Hospital in Los Angeles, California, from 2006 to the present time. Patient and tumor characteristics were documented, including treatment modality and whether SLNB was performed. Keck Medicine of the University of Southern California determined that institutional review board approval or human subjects committee approval and informed consent were not required for this retrospective study. All data were deidentified.Results | With preliminary data results from our institution spanning from 2006 to present, less than 0.1% of all patients with high-risk SCC tumors underwent SLNB procedures. Alternatively, 14.0% underwent complete lymph node dissections. A little more than half (56.7%) of these complete lymph node dissections had microscopic tumor metastasis to local lymph nodes, whereas 43.3% of them were free of metastasis.Discussion | Overall, we found prophylactic lymph node dissection to be overused and SLNB is underused in high-risk SCC. Given the cost and morbidity associated with prophylactic lymph node dissection, patients may benefit from a less invasive SLNB procedure before considering dissection. Limitations to SLNB include false-negative rates, particularly high for tumors on the head and neck because of alternate draining routes and bifurcating anatomy. Some view this as a contraindication for performing SLNB, but the use of single-photon emission computed tomography and preoperative lymphoscintigraphy can substantially decrease this false-negative rate. 6 An uncertainty to be explored is the next step in the trea...

Ms Morrison had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

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BACKGROUND Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer and has potential for regional or distant metastasis. Despite the standardization of features associated with high-risk cSCC, an advanced subset of cSCC, there is no established consensus regarding proper management of this tumor. OBJECTIVE To evaluate the efficacy of cetuximab, add to existing management options, and aid in the development of standardized treatment for this tumor. MATERIALS AND METHODS Medical records were searched using Current Procedural Terminology codes for cetuximab and cSCC. Demographic data and tumor characteristics, along with treatment regimens and follow-up times, were collected. A total of 20 cases were examined. RESULTS Of the 20 cases, 3 experienced a complete response and 7 experienced a partial response, yielding an overall response of 50% and a combined median disease-free survival of 6.35 months (range 1–46.8 months). CONCLUSION As most of the patients who experienced a response received cetuximab as part of a multimodality treatment approach, cetuximab may be most efficacious when administered with concurrent therapies such as surgery or radiation. Further larger prospective studies to determine the optimal dosing and frequency of cetuximab and the utility of concurrent therapies are warranted.

Patients with SCC of skin are more likely to have a history of hypothyroidism than the general population. The authors conclude that hypothyroidism may be linked to the development of cutaneous SCC.