Clinicopathological characteristics and clinical morbidity in high‐risk head and neck cutaneous squamous cell carcinoma patients in Western Australia

Abstract

Background: There is no registry data on morbidity and mortality of high-risk cutaneous squamous cell carcinoma (cSCC) in Australia.Aim: To examine the clinicopathological features, mortality and morbidity in high-risk cSCC patients in Western Australia (WA).Methods: A retrospective cohort study was conducted through hospital record review on cSCC patients discussed at multidisciplinary meetings at the two largest WA hospitals between March 2015 and December 2016.Results: Of 141 patients, 129 were evaluable, with median follow up of 43.9 (range 3.0-53.2) months. Patients were predominantly older males (84%) with significant comorbidities (Charlson Comorbidity Index (CCI) ≥5; 76%) and history of previous nonmelanoma skin cancer (57%) with advanced disease (57% stage IV without distant metastasis; American Joint Committee on Cancer, 7th edition). Pathological high-risk features were common including nodal extracapsular extension (47%) and cranial nerve involvement (16%). Clinical morbidity was significant with a median of 2 (range 0-13) excisions and 2 (range 0-21) cSCC-related hospitalisations for any cSCC event following the index case discussion. Recurrences of the primary index lesion occurred in 60% of patients and 20% had ≥2 recurrences. Median overall survival for patients with nonmetastatic disease was 39.8 (range 25.9-53.7) months and 16.1 (range 0.2-32.0) months for metastatic disease. CCI ≥5, advanced nodal stage and ≥2 recurrences were significantly associated with mortality on multivariable analyses (P < 0.05). Nodal extracapsular extension and any recurrences were identified as significant risk factors for disease-specific mortality on multivariable analyses (P < 0.05). Conclusion:High-risk cSCC patients have significant health needs represented by high-baseline comorbidities, multiplicity of cSCC events and the number of healthcareassociated interventions. There is an unmet need for robust cancer data collection.

Association of Patient Risk Factors, Tumor Characteristics, and Treatment Modality With Poor Outcomes in Primary Cutaneous Squamous Cell Carcinoma

“…Of these 129 studies, 114 studies assessed risk factors, with a total of 137 449 patients and 126 553 tumors. Of these, 87 studies with 122 484 tumors were included in the random effects analysis risk ratio, and 62 studies with 116 958 tumors were included in analysis of incidence data. Treatment modality was assessed by 28 studies…”

“…After inclusion criteria were applied, the full text of 310 articles were assessed. Of these, 129 studies were included in final analysis (Figure 1). Study characteristics, including risk of bias, are described in eTable 1 in the Supplement.…”

Metastatic patterns and treatment options for head and neck cutaneous squamous cell carcinoma (Review)

“…BCC normally exhibits localized, slow growth, but rarely metastasizes. The head and neck region, where >50% of newly diagnosed cSCC lesions are located, presents unique challenges in surgical treatment ( 3 ). In addition, the chances of survival of patients with cSCC are reduced by localized and/or distant metastases, and the disease is responsible for the death of 2% of patients annually worldwide.…”

Durvalumab and multimodality therapy in a patient with multiple recurrent and unresectable cutaneous squamous cell carcinoma

“…Grover et al 1 highlighted the significant morbidity experienced by patients with head and neck cutaneous squamous cell carcinoma (cSCC), which is a particular issue in Australia with its higher incidence. Surgery is the primary treatment, but locally advanced inoperable disease requires radiation and/or systemic therapy.…”