Nodal Staging of High Risk Cutaneous Squamous Cell Carcinoma

Publication date: Available online 15 September 2018

Source: Journal of the American Academy of Dermatology

Author(s): Matthew Fox, Marc Brown, Nicholas Golda, Dori Goldberg, Christopher Miller, Melissa Pugliano-Mauro, Chrysalyne Schmults, Thuzar Shin, Thomas Stasko, Yaohui G. Xu, Kishwer Nehal

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

Retrospective review of published peer-reviewed literature regarding risk stratification, nodal staging and treatment and outcomes for patients with HRcSCC via PubMed search.

Results

For patients without clinical lymphadenopathy, based on literature from head and neck SCC, pre-operative nodal staging with US may be more useful than CT or MRI. Since early nodal disease is usually curable, sentinel lymph node biopsy (SLNB) may be considered in those with negative imaging while we await studies of nodal staging outcomes.

Limitations

More data is needed to validate the relationships between primary tumor stage and SLNB 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 (BWH stage T2b and T3) in the absence of clinically palpable lymphadenopathy via radiographic imaging and, if negative, SLNB.