Abstract
Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women’s Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography–computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.
Highlights
We focus on invasive cutaneous squamous cell carcinoma (cSCC), excluding the early intra-epidermal SCC-like actinic keratoses (AK), Bowen’s disease, and mucosal SCCs, such as those located in the genital area, or those in the labialbuccal-nasal area, which are often mixed with cSCC under the label of ‘head and neck’ tumors
These guidelines will require updating approximately every 2 years but advances in medical sciences may demand an earlier update. These guidelines were written in order to assist clinicians in treating patients with invasive cutaneous squamous cell carcinoma. This update was initiated mainly due to advances in systemic treatments and a new American Joint Committee on Cancer (AJCC) staging system for patients with cSCC, which justify a newer approach to definitions, risk classification and multidisciplinary therapeutic strategies
Cutaneous SCC is a common skin cancer characterised by the malignant proliferation of epidermal keratinocytes and it is classified as a keratinocyte carcinoma together with basal cell carcinoma
Summary
These Guidelines were developed on behalf of the European Dermatology Forum (EDF), as decided at the EDF meeting in January 2017. The European Association of Dermato-Oncology (EADO) coordinated the authors’ contributions within its Guideline Program in Oncology (GPO). The editors and coordinators responsible for the formulation of the guideline are: Alexander J. In order to guarantee the interdisciplinary character of these guidelines, they were developed in cooperation with the European Organisation for Research and Treatment of Cancer (EORTC). Twenty-eight experts from 13 countries, all of whom were delegates of national and/or international medical societies, collaborated in the development of these guidelines
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