Consensus Guidelines for Staging and Surveillance Imaging in Cutaneous Squamous Cell Carcinoma

Area of Science:

• Oncology
• Radiology
• Dermatology

Background:

• Lack of consensus on staging and surveillance imaging for cutaneous squamous cell carcinoma (CSCC) leads to practice variability.
• Existing broad recommendations from the National Comprehensive Cancer Network (NCCN) have not fully standardized imaging use.
• Imaging plays a crucial role in managing CSCC, influencing treatment decisions.

Purpose of the Study:

• To develop multidisciplinary consensus recommendations for the use of staging and surveillance imaging in localized CSCC.
• To address the variability in clinical practice regarding CSCC imaging.
• To provide a framework for standardized imaging protocols.

Main Methods:

• A Delphi consensus method was employed, involving 3 iterative survey rounds from January to June 2025.
• Fifty-four experts were invited, and 45 (83%) completed all rounds, representing diverse specialties including dermatology, oncology, radiology, and surgery.
• Eligibility criteria ensured participants had significant expertise and experience in treating CSCC.

Main Results:

• Consensus was reached to recommend staging and surveillance for CSCCs with a ≥15% risk of metastasis.
• Specific criteria for imaging include concern for metastasis, bone invasion, invasion beyond subcutaneous fat, large-caliber nerve invasion, or tumors ≥4 cm.
• Computed tomography (CT) was the preferred modality for nodal staging and surveillance, with imaging recommended for at least 2-3 years.

Conclusions:

• This study provides an expert consensus-based framework to standardize imaging in localized CSCC.
• The recommendations can inform future clinical guidelines and improve consistency in CSCC management.
• Standardized imaging protocols are essential for optimal patient outcomes in CSCC.