A recent study aimed to improve cutaneous squamous cell carcinoma (cSCC) staging systems by determining risk factors from 2 large nationwide data sets.

“The high incidence of primary cSCC makes it challenging to correctly identify the small percentage… of patients who are at high risk of metastasis and would benefit from intense surveillance and/or adjuvant treatment strategies,” explained Selin Tokez, MSc, Department of Dermatology, Erasmus Medical Center Cancer Institute, University Medical Center Rotterdam, Rotterdam, the Netherlands, and colleagues.

Using 2 large data sets collected from English and Dutch nationwide cancer registry cohorts, 2 nested, case-controlled studies assessed various significant risk factors for metastasis in patients with cSCC. In cases and controls matched 1:1 on minimum follow-up time, multiple risk factors were identified, including 2 variables already highly associated with metastasis, thickness and diameter.

The English data set (n = 1774) found poor differentiation (odds ratio [OR] 4.56; 95% CI, 2.99 to 6.94), invasion in or beyond subcutaneous fat (OR 1.69; 95% CI, 1.05 to 2.71 and 4.43; 95% CI, 1.98 to 9.90, respectively), male sex (OR 2.59; 95% CI, 1.70 to 3.96), perineural/lymphovascular invasion (OR 2.12; 95% CI, 1.21 to 3.71), and facial localization (OR 1.57; 95% CI, 1.02 to 2.41) to be significant risk factors of metastatic cSCC. The Dutch data set (n = 434 cSCCs) yielded similar ORs. Neither data set found an observable linear relationship between metastasis and diameter and/or thickness.

“Risk factors for cutaneous squamous cell carcinoma metastasis have previously been investigated in small data sets with relatively few metastases,” wrote Dr Tokez et al, concluding, “cSCC staging systems can be improved by including differentiation, clinical characteristics such as sex and tumor location, and nonlinear relationships for diameter and thickness.”

Source:

Tokez S, Venables ZC, Hollestein LM, et al. Risk factors for metastatic cutaneous squamous cell carcinoma: Refinement and replication based on 2 nationwide nested case-control studies. J Am Acad Dermatol. 2022;87(1):64-71. doi:10.1016/j.jaad.2022.02.056