Radiologic imaging aids management of high-risk cutaneous squamous cell carcinoma: A retrospective cohort study

Radiologic imaging is not routinely performed to assess high-risk cutaneous squamous cell carcinoma (cSCC) as data on its utility are limited.

To determine the utilization of radiologic imaging and its impact on management in high-risk cSCC.

Retrospective cohort analysis of invasive cSCC at the Cleveland Clinic over a 25-year period. Patients with primary Brigham and Women's Hospital stage T2a high, T2b, T3, and recurrent cSCC tumors were included and stratified into imaged (n = 138) and nonimaged cohorts (n = 256).

Imaged tumors were more likely to be Brigham and Women's Hospital T2b/T3, located on the head and neck/trunk, moderately or poorly differentiated, and have a larger diameter, depth beyond fat, and perineural involvement compared to nonimaged tumors (all P < .001). Unexpected imaging findings were observed in 49% of imaged tumors, most commonly, local invasion beyond clinical expectations (23%) and nodal metastasis (18%). Imaging results changed clinical management in 47% of cases, often by altering surgical approach.

Single-institution retrospective study.

In high-risk cSCC, imaging reveals unexpected findings, particularly local invasion and nodal metastasis, leading to changes in management in approximately half of cases. Radiologic imaging, especially of the local site and nodal basins, should be considered in high-risk cSCC to aid staging and management planning.