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

Ruiz, Emily S.; Koyfman, Shlomo A.; Que, Syril Keena T.; Kass, Jason; Schmults, Chrysalyne D.

doi:10.1016/j.jaad.2019.07.048

Cited by 24 publications

(46 citation statements)

References 21 publications

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“…The studies described above provide supporting evidence for effective use of ART in high‐risk cSCC with respect to patient outcomes, while other recent studies suggest ART does not improve outcomes (Table 2). Ruiz et al compared surgical monotherapy (SM) to surgery plus ART (S + ART) in a retrospective primary cSCC cohort ( n = 62) having clear margins and negative LNs 75 . The authors matched for sex, age, immune status, surgery type, and tumor characteristics (i.e., diameter, depth, differentiation, and large‐caliber [≥0.1 mm] nerve invasion [LCNI]).…”

Section: Introductionmentioning

confidence: 99%

“…Additionally, the value of ART in cSCC, with or without clear margins, continues to be debated among clinicians due to lack of prospective, randomized clinical studies 7,71,80 . As described above, available literature is mostly from retrospective, small cohort, single‐site studies, and reported findings are conflicting regarding the effectiveness of ART in cSCC 63–66,68–70,73,75–77 …”

Section: Introductionmentioning

confidence: 99%

“…Ruiz et al compared surgical monotherapy (SM) to surgery plus ART (S + ART) in a retrospective primary cSCC cohort ( n = 62) having clear margins and negative LNs. 75 The authors matched for sex, age, immune status, surgery type, and tumor characteristics (i.e., diameter, depth, differentiation, and large‐caliber [≥0.1 mm] nerve invasion [LCNI]). They also performed a subanalysis to compare SM versus S + ART within the LCNI subgroup ( n = 33).…”

Section: Introductionmentioning

confidence: 99%

“…The National Comprehensive Cancer Network (NCCN) guidelines and the American College of Radiology (ACR) recommend ART for cSCC with extensive perineural invasion (PNI), large nerve involvement (nerve caliber ≥0.1 mm), or positive margins postsurgery (Table 3 ). 7 , 51 , 75 , 78 The American Academy of Dermatology (AAD) recommends consideration of ART to the primary cSCC site for concerning PNI, and when there is high risk for regional or distant metastasis (Table 3 ). 79 However, clear evidence is lacking regarding which high‐risk patients may benefit from ART following cSCC resection with clear margins.…”

Section: Introductionmentioning

confidence: 99%

“…7 , 71 , 80 As described above, available literature is mostly from retrospective, small cohort, single‐site studies, and reported findings are conflicting regarding the effectiveness of ART in cSCC. 63 , 64 , 65 , 66 , 68 , 69 , 70 , 73 , 75 , 76 , 77 …”

Section: Introductionmentioning

confidence: 99%

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Adjuvant therapy for high‐risk cutaneous squamous cell carcinoma: 10‐year review

Newman

Hall²,

Kurley³

et al. 2021

Head & Neck

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Standard of care for high‐risk cutaneous squamous cell carcinoma (cSCC) is surgical excision of the primary lesion with clear margins when possible, and additional resection of positive margins when feasible. Even with negative margins, certain high‐risk factors warrant consideration of adjuvant therapy. However, which patients might benefit from adjuvant therapy is unclear, and supporting evidence is conflicting and limited to mostly small retrospective cohorts. Here, we review literature from the last decade regarding adjuvant radiation therapy and systemic therapy in high‐risk cSCC, including recent and current trials and the role of immune checkpoint inhibitors. We demonstrate evidence gaps in adjuvant therapy for high‐risk cSCC and the need for prognostic tools, such as gene expression profiling, to guide patient selection. More large‐cohort clinical studies are needed for collecting high‐quality, evidence‐based data for determining which patients with high‐risk cSCC may benefit from adjuvant therapy and which therapy is most appropriate for patient management.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 3 more Smart Citations

Adjuvant therapy for high‐risk cutaneous squamous cell carcinoma: 10‐year review

Newman

Hall²,

Kurley³

et al. 2021

Head & Neck

Self Cite

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

et al. 2023

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ImportancePrimary cutaneous squamous cell carcinoma is usually curable; however, a subset of patients develops poor outcomes, including local recurrence, nodal metastasis, distant metastasis, and disease-specific death.ObjectivesTo evaluate all evidence-based reports of patient risk factors and tumor characteristics associated with poor outcomes in primary cutaneous squamous cell carcinoma and to identify treatment modalities that minimize poor outcomes.Data SourcesPubMed, Embase, and SCOPUS databases were searched for studies of the topic in humans, published in the English language, from database inception through February 8, 2022.Study SelectionTwo authors independently screened the identified articles and included those that were original research with a sample size of 10 patients or more and that assessed risk factors and/or treatment modalities associated with poor outcomes among patients with primary cutaneous squamous cell carcinoma.Data Extraction and SynthesisData extraction was performed by a single author, per international guidelines. The search terms, study objectives, and protocol methods were defined before study initiation. A total of 310 studies were included for full-text assessment. Owing to heterogeneity of the included studies, a random-effects model was used. Data analyses were performed from May 25 to September 15, 2022.Main Outcomes and MeasuresFor studies of risk factors, risk ratios and incidence proportions; and for treatment studies, incidence proportions.ResultsIn all, 129 studies and a total of 137 449 patients with primary cutaneous squamous cell carcinoma and 126 553 tumors were included in the meta-analysis. Several patient risk factors and tumor characteristics were associated with local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death were identified. Among all factors reported by more than 1 study, the highest risks for local recurrence and disease-specific death were associated with tumor invasion beyond subcutaneous fat (risk ratio, 9.1 [95% CI, 2.8-29.2] and 10.4 [95% CI, 3.0- 36.3], respectively), and the highest risk of any metastasis was associated with perineural invasion (risk ratio, 5.0; 95% CI, 2.3-11.1). Patients who received Mohs micrographic surgery had the lowest incidence of nearly all poor outcomes; however, in some results, the 95% CIs overlapped with those of other treatment modalities.Conclusions and RelevanceThis meta-analysis identified the prognostic value of several risk factors and the effectiveness of the available treatment modalities. These findings carry important implications for the prognostication, workup, treatment, and follow-up of patients with primary cutaneous squamous cell carcinoma.Trial RegistrationPROSPERO Identifier: CRD42022311250

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Other Skin Cancers

McMurray¹,

Stebbins²,

Millican³

et al. 2022

Holland‐Frei Cancer Medicine

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Overview Nonmelanoma skin cancer (NMSC) includes squamous cell carcinoma (SCC), basal cell carcinoma (BCC), Merkel cell carcinoma (MCC), and other premalignant and malignant tumor types. The incidence of NMSC has increased significantly in recent years. These cancers are diverse in their clinical presentation, biology, and capacity to metastasize. Our understanding of the molecular biology of NMSC has grown considerably in recent years, leading to the development of new treatment options. In addition to malignant NMSC, this article will discuss several benign skin tumors that arise due to underlying internal malignancies.

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

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

Cited by 24 publications

References 21 publications

Adjuvant therapy for high‐risk cutaneous squamous cell carcinoma: 10‐year review

Adjuvant therapy for high‐risk cutaneous squamous cell carcinoma: 10‐year review

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

Other Skin Cancers

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