A 5-year follow-up study of 633 cutaneous SCC excisions: rates of local recurrence and lymph node metastasis

Publication date: Available online 2 May 2018
Source:Journal of Plastic, Reconstructive & Aesthetic Surgery
Author(s): K. Khan, R. Mykula, R. Kerstein, N. Rabey, T. Bragg, A. Crick, S. Heppell, P. Budny, M. Potter
BackgroundA 5-year follow-up study of 633 cutaneous squamous cell cancer (SCC) excisions was performed collecting data on rates of local recurrence and nodal metastasis.MethodsA retrospective analysis of patients was performed across 4 regional plastic surgery centres (Stoke Mandeville Hospital, Aylesbury, John Radcliffe Hospital, Oxford, Salisbury District Hospital, Salisbury, and Queen Alexandra Hospital, Portsmouth) assessing rates of local recurrence and nodal metastasis.ResultsWe report 5-year outcomes from 598 SCCs (95% follow-up rate). The total recurrence rate (local recurrence and nodal metastasis) was 6.7% (n = 40) at 5 years, with 96% of these occurring within 2 years. Median time to local recurrence was 9 months (1-57), with 76.9% (n = 20) undergoing further wide local excision. Median time to lymph node metastasis was 5.5 months (1-18 months). There were two cases of disease-related death. Only 15% (n = 6) of incomplete excisions recurred. Interestingly, 19.1% (n=9) of 47 SCCs with perineural invasion on original histopathology recurred versus only 5.6% (n=31) of the 551 SCCs without perineural invasion (p = 0.005).ConclusionsThis study is one of the largest studies to date following up 598 SCC excisions at 5-years with total recurrence rates comparable to current published literature. We report perineural invasion as a significant predictor of recurrence and that 96% of total recurrence occurred within 2 years. This is in contrast to current U.K. guidelines (75% at 2 years, 95% at 5 years) suggesting shorter length of hospital follow-up may be reasonable.