Sentinel Lymph Node Biopsy for Cutaneous Squamous Cell Carcinoma.

Area of Science:

• Oncology
• Surgical Oncology
• Dermatology

Background:

• Cutaneous squamous cell carcinoma (cSCC) prognosis declines with metastasis.
• The role of sentinel lymph node biopsy (SLNB) in detecting cSCC metastasis is not well-defined.
• SLNB is crucial for staging and guiding treatment in various skin cancers.

Purpose of the Study:

• To evaluate the role of SLNB in managing cSCC using the National Cancer Database (NCDB).
• To compare overall survival (OS) between patients undergoing complete surgical excision (CSE) alone versus CSE with SLNB.
• To assess the impact of completion lymph node dissection (CLND) on OS in SLNB-positive patients.

Main Methods:

• Retrospective analysis of 2730 cSCC patients from the NCDB (2012-2020).
• Comparison of OS between CSE alone and CSE + SLNB cohorts.
• Subgroup analyses of SLNB status and CLND, with adjusted hazard ratios (aHR) calculated.

Main Results:

• 42.3% of patients underwent SLNB, with 15.4% positive.
• SLNB was associated with improved OS (aHR 0.70; p<.001) compared to CSE alone.
• Positive SLNB (aHR 2.82; p<.0001) and CLND (aHR 0.63; p=0.221) did not show OS benefit.

Conclusions:

• SLNB demonstrated an overall survival benefit in cSCC patients.
• Completion lymph node dissection (CLND) did not provide an OS benefit.
• Further studies are required to establish the definitive role of SLNB in cSCC management, considering potential selection bias and emerging adjuvant therapies.