Five Risk Factors for Poor Outcomes in Cutaneous SCC
Five Risk Factors for Poor Outcomes in Cutaneous SCC
Most cases of cutaneous squamous cell carcinoma (SCC) are curable with surgery or ablation, but the skin cancer still carries a risk for metastasis and death.
In a new single-center retrospective study, researchers from Brigham and Women's Hospital in Boston, Massachusetts, identified 5 risk factors that are associated with these poor outcomes.
They are a tumor diameter of at least 2 cm; invasion beyond fat; poor cellular differentiation; perineural invasion; and ear, temple, or anogenital location.
The study results appear in the May issue in JAMA Dermatology.
Previous studies have identified these factors and others as risks for metastasis and death. However, this study is the first with enough patients to calculate the risk for poor outcomes with multivariate modeling. In short, the study attempts to provide a more precise definition of high-risk cutaneous SCC.
Lead author Chrysalyne D. Schmults, MD, and colleagues reviewed hospital electronic case files from 2000 to 2009 and found 985 patients diagnosed with cutaneous SCC who had a total of 1832 tumors. The median follow-up was 50 months.
During the study period, 45 patients (4.6%) developed local recurrence, 36 (3.7%) developed nodal metastases, and 21 (2.1%) died of cutaneous SCC.
The study did not include any genetic information about the skin cancers, Dr. Schmults told Medscape Medical News.
"Very little is known about the impact of genes on cutaneous SCC prognostics, and no genetic studies are currently performed on cutaneous SCC tumor specimens," she explained.
However, work has begun. "We and others are beginning studies aimed at defining genetic alterations that affect SCC prognosis, but it will likely be several years before such factors can be incorporated into prognostic models," Dr. Schmults noted.
This study does have a shortcoming, Fiona Zwald, MD, from Emory University in Atlanta, Georgia, who was not involved in the study, writes in an accompanying comment.
Namely, there were too few patients with immunosuppression in the cohort (only 15%), she reports.
"Immunosuppression contributes negatively to the prognosis and outcome of patients with cutaneous SCC," she writes. However, because it does not neatly fit into the TNM criteria that are the backbone of staging, immunosuppression has not been included in the recent staging system developed for cutaneous SCC, she points out.
Dr. Schmults and colleagues acknowledge that immunosuppression is a risk factor for poor outcome. They also admit that their study was underpowered to completely assess all risk factors for cutaneous SCC, including immunosuppression.
More extensive studies of population-based data are required to determine the "optimal management" of high-risk cutaneous SCC, as are clinical trials that prove the utility of disease-staging modalities, they write.
The study authors and Dr. Zwald have disclosed no relevant financial relationships.
JAMA Dermatol. 2013;149:541-547, 547-548. Abstract, Comment
Most cases of cutaneous squamous cell carcinoma (SCC) are curable with surgery or ablation, but the skin cancer still carries a risk for metastasis and death.
In a new single-center retrospective study, researchers from Brigham and Women's Hospital in Boston, Massachusetts, identified 5 risk factors that are associated with these poor outcomes.
They are a tumor diameter of at least 2 cm; invasion beyond fat; poor cellular differentiation; perineural invasion; and ear, temple, or anogenital location.
The study results appear in the May issue in JAMA Dermatology.
Previous studies have identified these factors and others as risks for metastasis and death. However, this study is the first with enough patients to calculate the risk for poor outcomes with multivariate modeling. In short, the study attempts to provide a more precise definition of high-risk cutaneous SCC.
Lead author Chrysalyne D. Schmults, MD, and colleagues reviewed hospital electronic case files from 2000 to 2009 and found 985 patients diagnosed with cutaneous SCC who had a total of 1832 tumors. The median follow-up was 50 months.
During the study period, 45 patients (4.6%) developed local recurrence, 36 (3.7%) developed nodal metastases, and 21 (2.1%) died of cutaneous SCC.
The study did not include any genetic information about the skin cancers, Dr. Schmults told Medscape Medical News.
"Very little is known about the impact of genes on cutaneous SCC prognostics, and no genetic studies are currently performed on cutaneous SCC tumor specimens," she explained.
However, work has begun. "We and others are beginning studies aimed at defining genetic alterations that affect SCC prognosis, but it will likely be several years before such factors can be incorporated into prognostic models," Dr. Schmults noted.
This study does have a shortcoming, Fiona Zwald, MD, from Emory University in Atlanta, Georgia, who was not involved in the study, writes in an accompanying comment.
Namely, there were too few patients with immunosuppression in the cohort (only 15%), she reports.
"Immunosuppression contributes negatively to the prognosis and outcome of patients with cutaneous SCC," she writes. However, because it does not neatly fit into the TNM criteria that are the backbone of staging, immunosuppression has not been included in the recent staging system developed for cutaneous SCC, she points out.
Dr. Schmults and colleagues acknowledge that immunosuppression is a risk factor for poor outcome. They also admit that their study was underpowered to completely assess all risk factors for cutaneous SCC, including immunosuppression.
More extensive studies of population-based data are required to determine the "optimal management" of high-risk cutaneous SCC, as are clinical trials that prove the utility of disease-staging modalities, they write.
The study authors and Dr. Zwald have disclosed no relevant financial relationships.
JAMA Dermatol. 2013;149:541-547, 547-548. Abstract, Comment
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