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Cutaneous Squamous Cell Carcinoma Landscape

High-Risk Cutaneous Squamous Cell Carcinoma (SCC)

Cutaneous squamous cell carcinoma (SCC) is an emerging, and potentially underappreciated, problem in the US. Patients with one or more risk factors suffer the majority of SCC mortality, but these factors alone are often not specific enough to determine their risk-appropriate treatment and further management.

Because cancer treatment plans and their outcomes are guided by risk of metastasis, improved prognostic accuracy has direct implications on patient management. Risk-appropriate management is currently limited by classification systems (NCCN, BWH, AJCC) with low positive predictive value.

Prognostic Risk Factors for Cutaneous Squamous Cell Carcinoma

There are a number of approaches to determine risk for patients diagnosed with cutaneous squamous cell carcinoma. These approaches have high sensitivity but low positive predictive value.

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Risk Factor 1

T1 (0 factors), T2a (1), T2b (2-3) or T3 (>4 or bone invasion)

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Risk Factor 1

T1 (0 factors), T2a (1), T2b (2-3) or T3 (>4 or bone invasion)

CastleLogoWhite

Risk Factor 1

T1 (0 factors), T2a (1), T2b (2-3) or T3 (>4 or bone invasion)

BWH Tumor Staging System

BWH Tumor Staging System

T1 (0 factors), T2a (1), T2b (2-3) or T3 (>4 or bone invasion)

Factors include:

  • Tumor diameter >2 cm
  • Poorly differentiated histology
  • Perineural invasion >0.1 mm
  • Tumor invasion beyond fat

Presence of Specific Risk Factors

Presence of Specific Risk Factors

Factors include:

  • Tumor diameter >2 cm
  • Specific tumor locations (for example, ear, lip, cheek or temple)
  • Patient immunocompromise
  • Tumor invasion beyond fat
  • Poorly differentiated histology
  • Perineural invasion >0.1 mm

NCCN High-Risk

NCCN High-Risk

One or more of a large number of possible factors (broadest high-risk characterization)

Similar to Mohs Appropriate Use Criteria[JS1]

[JS1]Review with client, not clear on

how this works

1

Cutaneous Squamous Cell Carcinoma Metastasis and Survival

Cutaneous squamous cell carcinoma (SCC) mortality is increasing and is now estimated to be greater than that for melanoma. Unlike melanoma, metastatic SCC arises almost exclusively from a subset of patients. This subset can be excluded from additional prognosis with high negative predictive value for metastasis.

  • 15,000 Annual patients deaths from SCC

    0%
  • 12,000 Annual patient deaths from melanoma

    0%

Established management approaches (for primary treatment and follow up / surveillance) provide potential for reduced or earlier detection of metastasis as well as improved survival.

Challenge-Identify True Risk for Patients with One or More Risk Factors

Not all SCC patients who are identified as high risk based on the presence of one or more risk factors will truly be at high risk of metastasis. If we can improve identification of those at greatest risk, we can address metastatic risk while minimizing potential overtreatment for those who would not benefit. Conversely, the low predictive value of current methods to identify high-risk patients can lead to undertreatment if patients with a truly high biologic risk are missed. Because these patients cannot currently be identified, they will miss the opportunity to receive the most aggressive of today’s therapeutic options.

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Call: 866-788-9007

Podcast

A Review of the DecisionDx-SCC Clinical Validation Study in Future Oncology

by Dr. Sherrif F. Ibrahim

Enhanced Metastatic Risk Assessment in Cutaneous Squamous Cell Carcinoma with the 40-Gene Expression Profile Test: An Interview with the Lead Author of DecisionDx-SCC’s Validation Study.

Speaker: Sherrif F. Ibrahim, MD, PhD., Assistant Professor, Department of Dermatology, University of Rochester Medical Center

Video Webinar

An Introduction to DecisionDx–SCC by Dr. Jason Newman, UPenn

AHNS DecisionDx–SCC Webinar: Identifying the Risk of Metastasis in cSCC and cSCC-HN Patients

Speaker: Dr. Jason Newman, Professor of Otorhinolaryngology - Head and Neck Surgery, University of Pennsylvania

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