An evolving paradigm for the workup and management of high-risk cutaneous squamous cell carcinoma - 19/07/13

Doi : 10.1016/j.jaad.2013.05.011

Kevin O’Bryan, MD ^a, William Sherman, MD ^b, George W. Niedt, MD ^c, Bret Taback, MD ^d, Spiros Manolidis, MD ^e, Antai Wang, PhD ^f, Désirée Ratner, MD ^g,^⁎
^a Department of Dermatology, Division of Dermatologic Surgery, Columbia University Medical Center, New York, New York
^b Department of Internal Medicine, Division of Oncology, Columbia University Medical Center, New York, New York
^c Department of Dermatology, Division of Dermatopathology, Columbia University Medical Center, New York, New York
^d Department of Surgery, Columbia University Medical Center, New York, New York
^e Department of Head and Neck Surgery, Albert Einstein School of Medicine, New York, New York
^f Department of Biostatistics, Columbia University Mailman School of Public Health, New York, New York
^g Department of Dermatology, Beth Israel Medical Center and St Luke’s and Roosevelt Hospitals, New York, New York

^∗Reprint requests: Désirée Ratner, MD, Beth Israel Cancer Center West, 325 W 15 St, New York, NY 10011.

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Friday 19 July 2013

Abstract

Background

No established standard of care exists for aggressive cutaneous squamous cell carcinoma (CSCC).

Objective

We sought to establish an aggressive CSCC management protocol by reviewing high-risk CSCC (HCSCC) and very high-risk CSCC (VCSCC) cases at our institution.

Methods

This was a retrospective review of all CSCC cases treated at our institution.

Results

A total of 27 patients were identified of 1591 cases treated between 2000 and 2011. Four patients with HCSCC received surgery alone and 1 received surgery and radiation. All remain disease free (median follow-up 5 years). Among patients with VCSCC, 4 received surgery alone: 1 (25%) showing a complete response and 3 (75%) showing disease progression. Eleven received surgery and radiation: 4 (36.4%) with complete response (median follow-up 3 years) and 7 (63.6%) with disease progression (median time to recurrence 6 months). Six received surgery and cetuximab: 3 (50%) had a complete response (median follow-up 3 years), 2 (33%) had disease progression, and 1 (14%) could not be assessed because of inability to tolerate infusions. One patient received surgery, cetuximab, and radiation, and remains disease-free after 4 years.

Limitations

Lack of randomization, blinding, a true control arm, or standardization of treatment protocols are limitations.

Conclusions

Patients with very HCSCC may have improved outcomes with surgery and adjuvant cetuximab.

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Key words : carcinoma, cetuximab, cutaneous, epidermal growth factor receptor, radiation, skin, squamous

Abbreviations used : CR, CSCC, EGFR, HCSCC, SCC, SCCHN, VCSCC

Esquema

Methods

Results

Discussion

Surgical monotherapy for HCSCC

Management of VCSCC

Limitations and conclusions

	Funding sources: None.
	Conflicts of interest: None declared.
	Presented at the 2012 American College of Mohs Surgery Annual Meeting, Chicago, IL, May 2012.