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 accuracy 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.