Management of cutaneous squamous cell carcinoma at high risk of recurrence

BCC: basal cell carcinoma; CCPDMA: complete circumferential peripheral and deep margin assessment; cSCC: cutaneous squamous cell carcinoma; PD-1: programmed cell death protein 1.

* Definition of high-risk primary cSCC.^[1]

• High-risk cSCCs:
  • Lesions of any size located on head, neck, hands, feet, pretibia, and anogenital area
  • Lesions ≥2 cm located on trunk or extremities (excluding pretibia, hands, and feet)
  • Recurrent tumor
  • Histopathologically acantholytic (adenoid), adenosquamous (showing mucin production), or metaplastic (carcinosarcomatous) subtypes, with perineural invasion
• Very high-risk cSCC:
  • Lesions ≥4 cm on any location
  • Histopathologically poorly differentiated tumor, desmoplastic cSCC, >6 mm in thickness or invasion beyond the subcutaneous fat
  • Perineural invasion – Tumor cells within the nerve sheath of a nerve lying deeper than the dermis or ≥0.1 mm
  • Lymphatic or vascular involvement

¶ Refer to the UpToDate topics on the systemic treatment of advanced BCCs and cSCCs not amenable to local therapies for detailed discussion of immunotherapy and other systemic therapies.