Nodal staging of high-risk cutaneous squamous cell carcinoma - 07/02/19

Doi : 10.1016/j.jaad.2018.09.006

Matthew Fox, MD ^a,^⁎ , Marc Brown, MD ^b, Nicholas Golda, MD ^c, Dori Goldberg, MD ^d, Christopher Miller, MD ^e, Melissa Pugliano-Mauro, MD ^f, Chrysalyne Schmults, MD, MSCE ^g, Thuzar Shin, MD, PhD ^e, Thomas Stasko, MD ^h, Yaohui G. Xu, MD, PhD ⁱ, Kishwer Nehal, MD ^j
from the
High Risk Squamous Cell Carcinoma Workgroup
Dermatologic Surgery Section of the Association of Professors of Dermatology
^a Division of Dermatology at Dell Medical School, University of Texas at Austin, Austin, Texas
^d Division of Dermatology, University of Massachusetts Medical School, Worcester, Massachusetts
^b Department of Dermatology at the University of Rochester, Rochester, New York
^c Department of Dermatology, University of Missouri, Columbia, Missouri
^e Department of Dermatology, Hospital of the University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania
^f Department of Dermatology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
^g Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
^h Department of Dermatology, University of Oklahoma, Norman, Oklahoma
ⁱ Department of Dermatology, University of Wisconsin School of Medicine and Public Health, Milwaukee, Wisconsin
^j Department of Medicine, Dermatology Service, Memorial Sloan Kettering Cancer Center, New York, New York

^∗Correspondence to: Matthew Fox, MD, Division of Dermatology, Dell Medical School, University of Texas at Austin, 1601Trinity St, Ste 704, Austin, TX 78712.Division of DermatologyDell Medical SchoolUniversity of Texas at Austin1601Trinity StSte 704AustinTX78712

Sous presse. Épreuves corrigées par l'auteur. Disponible en ligne depuis le Thursday 07 February 2019
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Abstract

Background

While progress has been made in defining the clinical and histopathologic features of high-risk cutaneous squamous cell carcinoma (HRcSCC), optimal staging guidelines remain elusive.

Objective

We seek to guide clinical practice regarding nodal staging options for patients with HRcSCC via review of evolving definitions of HRcSCC, nodal staging options, and how nodal staging may impact treatment and affect outcomes.

Methods

This was a retrospective review of the published peer-reviewed literature regarding risk stratification, nodal staging, and treatment and outcomes for patients with HRcSCC via PubMed.

Results

For patients without clinical lymphadenopathy, based on literature from head and neck SCC, preoperative nodal staging with ultrasonography may be more useful than computed tomography or magnetic resonance imaging. Early nodal disease is usually curable, and therefore obtaining a sentinel lymph node biopsy specimen may be considered in those with negative imaging while we await studies of nodal staging outcomes.

Limitations

More data are needed to validate the relationships between primary tumor stage and sentinel lymph node biopsy status and to determine if early detection of nodal disease impacts survival for patients with HRcSCC.

Conclusion

It is reasonable to consider nodal staging for patients with HRcSCC (Brigham and Women's Hospital stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, sentinel lymph node biopsy.

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Key words : nodal staging, sentinel lymph node biopsy, squamous cell carcinoma

Plan

Modalities for evaluating regional metastasis in HRcSCC

Clinical examination

Imaging

USgFNA

Summary of radiologic data for cSCC nodal staging

SLNB

Discussion

	Funding sources: None.
	Conflicts of interest: Dr Schmults developed the Brigham and Women's Hospital staging system for high-risk squamous cell carcinoma referenced herein. Drs Nehal and Schmults are members of the American Joint Committee on Cancer cutaneous squamous cell carcinoma subcommittee for the American Joint Committee on Cancer 8th edition. The other authors have no conflicts of interest to disclose.