Cutaneous squamous cell carcinoma and the emerging role of sentinel lymph node biopsy

Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and is usually associated with a favorable prognosis in most patients. However, a small minority of patients will be diagnosed with a high-risk cSCC (HRcSCC) and a proportion will have a poor outcome, in some cases causing death. HRcSCC is characterized by an increase in aggressiveness manifested as local recurrence, the development of lymph node metastases, and occasionally death. The utility of sentinel lymph node biopsy (SLNB) in this group of patients is unclear without high-level evidence or clear-cut recommendations. If clinicians accept as a cut-off threshold of a >10% of risk of harboring occult nodal metastasis, then selected HRcSCC patients may benefit from SLNB and/or additional investigations. Herein, we performed a review of the current evidence regarding SLNB in HRcSCC. We believe that SLNB may be considered in selected HRcSCC patients to potentially better predict prognosis and influence management. However larger prospective studies are needed to better define the subset of patients that may benefit from SLNB and if early detection of occult nodal metastases is associated with an improved outcome.