Cutaneous squamous cell carcinoma staging may influence management in users: A survey study

Area of Science:

• Oncology
• Dermatology
• Surgical Oncology

Background:

• Cutaneous squamous cell carcinoma (CSCC) is a common skin cancer requiring multidisciplinary management.
• Variations in staging and treatment approaches may impact patient outcomes.
• Understanding consensus and discrepancies among specialties is crucial for optimizing CSCC care.

Purpose of the Study:

• To assess consensus on high-risk features, staging, and management of CSCC among different medical specialties.
• To identify differences in CSCC management strategies between dermatologists and other cancer specialists (OCS).

Main Methods:

• A survey was distributed to dermatology, head and neck surgery, surgical oncology, radiation oncology, and medical oncology experts.
• The survey focused on high-risk features, staging systems (Brigham and Women's Hospital [BWH] and American Joint Committee on Cancer [AJCC]), and management of CSCC.
• 156 physicians completed the survey, representing a 46% response rate.

Main Results:

• High-risk CSCC features with consensus (>80%) include depth of invasion, perineural invasion, histologic differentiation, and patient immunosuppression.
• Dermatologists were more likely to use clinical tumor diameter and histology as high-risk features.
• Dermatologists preferred the BWH staging system, while OCS predominantly used the AJCC system; however, many respondents did not consistently use staging for treatment decisions beyond surgery.

Conclusions:

• Significant consensus exists on high-risk CSCC features, but differences in staging system utilization (BWH vs. AJCC) and management patterns persist between dermatologists and OCS.
• High-risk CSCC is generally defined as BWH T2b or higher and AJCC T3 or higher, guiding consideration for treatments beyond surgery.
• Further research is needed to develop a comprehensive, risk-based management strategy for CSCC.