Clinical outcomes in high-risk squamous cell carcinoma patients treated with Mohs micrographic surgery alone

European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment

“…Surgical excision including appropriate safety margins of clinically normal skin with postoperative margin assessment is the standard treatment of invasive cSCC [11]. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision [14] and negative margins as reported by the pathology report are necessary to minimise the risk of local recurrence and metastasis [9,15,16].…”

“…More recently, two retrospective studies supported the value of MMS in prevention of local recurrence. In one study, including 647 high-risk cSCC, there were 19 local recurrences (2.9%), 31 nodal metastases (4.8%), 7 distant metastases (1.1%), and 7 diseasespecific deaths (1.1%) [9]. Two factors, poor differentiation and invasion beyond the subcutaneous fat, were positively associated with local recurrence, nodal metastasis, and disease-specific death.…”

“…Guideline adaptation [16] Systematic review [15] Retrospective study [9] Strength of consensus: 100% *As the independent prognostic effect of high-risk factors has not been consistently reported, a specific recommendation on the clinical safety margins cannot be given, but should fall within the 6-to 10 -mm range and be based on individual risk assessment and a constellation of tumour-and patient-related characteristics.…”

Cutaneous Squamous Cell Carcinoma: From Pathophysiology to Novel Therapeutic Approaches

“…A common therapeutic approach for cSCC is the standard excision followed by postoperative margin assessment. Safety margins with clinical normal-appearing tissue around the tumor and negative margins as reported by the pathology are needed to minimize the risk of local recurrence and metastasis [140][141][142]. It has been reported that this technique guarantees a five-year disease-free rate of 91% or higher for cSCC [143,144].…”

Evaluation of the utility of localized adjuvant radiation for node-negative primary cutaneous squamous cell carcinoma with clear histologic margins

“…16 A recent study of 647 CSCCs treated with only MMS found that 10%, 17%, 5%, and 5% of 145 high-stage CSCCs (defined as BWH T2b/T3) the risk of LR was only 10%. 17 ART for epithelial tumors is offered when the risk of recurrence exceeds 15-20%. Since radiation is not expected to impact nodal or distant metastasis, a 10% LR risk for high-stage CSCC may not be high enough for radiation to significantly impact recurrence risk.…”