High-Risk Cutaneous Squamous Cell Carcinoma

Abstract

The aim of this report is to review the literature on patients diagnosed with a “high-risk” cutaneous squamous cell carcinoma (cSCC), defined as the subset (5–10%) of cSCC patients at increased risk of developing predominantly local and/or regional recurrence and, to a lesser extent, distant metastasis. There are no universally accepted criteria for defining or managing patients with a high-risk cSCC. We reviewed the literature and examined risk stratification, management strategies, and promising future directions. A new staging system, from the Brigham and Women’s Hospital, has provided important data on high-risk cSCC patients, highlighting the increasing risks associated with the interaction of a number of high-risk independent variables a patient has. Only a minority of cSCC patients can be considered as high risk for developing recurrence and potentially dying from cSCC. Most patients are cured following local treatment, usually surgery. It is the high-risk patients that need to be identified and managed appropriately, often requiring multimodality treatment.