Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up

Abstract

Cutaneous squamous cell carcinomas (cSCC) are amongst the most common cancers with metastatic potential. Specific clinical and pathological “high-risk” features are used to determine the risk of loco-regional recurrence. 1 SIGN Management of primary cutaneous squamous cell carcinoma. Scott Intercoll Guidel Netw (SIGN). 2014; 140 Google Scholar , 2 Brantsch K.D. Meisner C. Schönfisch B. et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008; 9: 713-720https://doi.org/10.1016/s1470-2045(08)70178-5 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar , 3 Farasat S. Yu S.S. Neel V.A. et al. A new American Joint Committee on Cancer staging system for cutaneous squamous cell carcinoma: creation and rationale for inclusion of tumor (T) characteristics. J Am Acad Dermatol. 2011; 64: 1051-1059https://doi.org/10.1016/j.jaad.2010.08.033 Abstract Full Text Full Text PDF PubMed Scopus (183) Google Scholar , 4 Karia P.S. Jambusaria-Pahlajani A. Harrington D.P. et al. Evaluation of American Joint Committee on Cancer, International Union Against Cancer, and Brigham and Women's Hospital tumor staging for cutaneous squamous cell carcinoma. J Clin Oncol. 2014; 32: 327-334https://doi.org/10.1200/jco.2012.48.5326 Crossref PubMed Scopus (0) Google Scholar Current national guidelines recommend that patients with “high-risk” disease receive specialist follow-up for 2–3 years. 1 SIGN Management of primary cutaneous squamous cell carcinoma. Scott Intercoll Guidel Netw (SIGN). 2014; 140 Google Scholar Whilst guidance on what constitutes “high-risk” disease appears consistent and evidence-based, 1 SIGN Management of primary cutaneous squamous cell carcinoma. Scott Intercoll Guidel Netw (SIGN). 2014; 140 Google Scholar guidance on what constitutes “low-risk” disease is comparatively vague (despite good evidence suggesting minimal risk in the absence of “high-risk” factors 2 Brantsch K.D. Meisner C. Schönfisch B. et al. Analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: a prospective study. Lancet Oncol. 2008; 9: 713-720https://doi.org/10.1016/s1470-2045(08)70178-5 Abstract Full Text Full Text PDF PubMed Scopus (0) Google Scholar ), which could result in unnecessary follow-up regimens that are more reflective of local preferences. We hypothesised that, contrary to national guidelines, 1 SIGN Management of primary cutaneous squamous cell carcinoma. Scott Intercoll Guidel Netw (SIGN). 2014; 140 Google Scholar patients with “low-risk” cSCC were unnecessarily reviewed in our out-patient clinics for extended periods of time. We undertook a review of outcomes for sporadic primary cSCC in our department, with the objective of identifying a sub-group of “low-risk” patients suitable for discharge to primary care without extended out-patient follow-up. Reply to: ‘Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up’Journal of Plastic, Reconstructive & Aesthetic SurgeryVol. 70Issue 9PreviewWe read with great interest the paper entitled ‘Patients with low-risk cutaneous squamous cell carcinoma do not require extended out-patient follow-up,’ by Rose et al.1 The article raised some excellent points regarding the necessity and sustainability of regular specialist follow-up of low-risk squamous cell carcinoma (SCC). We too have recently conducted an analysis of SCC recurrence and follow-up schedules via a retrospective analysis of SCCs excised by the senior author over a 2-year period from January 2014 to January 2016. Full-Text PDF