Recurrence and Metastasis in Cutaneous Squamous Cell Carcinoma: Clinicopathological Predictors From a 15-Year...

Cutaneous squamous cell carcinoma (cSCC) is one of the most common non-melanoma skin cancers and carries a clinically significant risk of recurrence and metastasis. Identifying reliable prognostic factors is essential for improving risk stratification. This study evaluated the clinicopathological predictors of recurrence and metastasis in primary cSCC lesions treated at a large tertiary center over a 15-year period.

Demographic, clinical, and pathological data were collected for 428 surgically treated primary cSCC lesions between 2008 and 2022. The variables included tumor size, histological differentiation, histological subtype, anatomical site, and surgical margin status. Clinical outcomes were defined as local recurrence and nodal or distant metastasis. Associations between variables and outcomes were evaluated using appropriate univariate statistical tests. Univariable and multivariable binary logistic regression analyses were performed to identify independent predictors of local recurrence.

The mean age was 71.5 years. During follow-up, local recurrence occurred in 4.5% of cases, nodal metastasis in 4.7%, and distant metastasis in 1.9%. Larger tumors had higher recurrence (10.2%) and metastasis rates (15.4%), particularly lesions exceeding 3 cm. Poor differentiation was associated with nodal metastasis (10.1%). Positive surgical margins were associated with both recurrence and metastasis (p=0.022). In the multivariable binary analysis, increasing tumor size and positive surgical margins were identified as independent predictors of local recurrence.

Tumor size, histological differentiation, anatomical site, histological subtype, and surgical margin status are critical prognostic factors in cSCC. Drawing on a large single-center cohort from Türkiye, our findings highlight the importance of margin control and vigilant follow-up in high-risk patients.