Study Suggests Cuataneous Squamous Cell Carcinoma Carries Risk of Metastasis and Death

A study by Chrysalyne D. Schmults, M.D., M.S.C.E., of Brigham and Women’s Hospital, Boston, and colleagues suggests cutaneous squamous cell carcinoma (CSCC) carries a low but significant risk of metastasis and death.

The ten-year retrospective cohort study was conducted at an academic medical center in Boston, and included 985 patients with 1,832 tumors. Main measures of the study were subhazard ratios for local recurrence, nodal metastasis, disease-specific death, and all-cause death adjusted for presence of known prognostic risk factors. The median follow-up was 50 months.

Local recurrence occurred in 45 patients (4.6 percent) during the study period; 36 (3.7 percent) developed nodal metastases; and 21 (2.1 percent) died of CSCC. Independent predictors for nodal metastasis and disease-specific death were tumor diameter of at least 2 centimeters, poor differentiation, invasion beyond fat, and ear or temple location. Perineural invasion, cancer spreading to the space surround a nerve, was also associated with disease-specific death, as was anogenital location. Overall death was associated with poor differentiation and invasion beyond fat, the study finds.

“Tumor diameter of at least 2 centimeters, invasion beyond fat, poor cellular differentiation, perineural invasion, and ear, temple, or anogenital location were risk factors for poor outcomes. These 5 risk factors may be among the most significant drivers of CSCC outcomes, but further studies are needed to replicate our findings” the authors conclude.

(JAMA Dermatol. Published May 15, 2013. 2013;149(5):541-547.