Mortality Risk From Squamous Cell Skin Cancer

TLDR

The study aims to identify squamous cell carcinoma patients at greatest risk of disease‑specific mortality. Patients with confirmed SCC lesions were prospectively enrolled, treated to complete remission, and followed for at least two months with comprehensive clinical and pathologic evaluations to assess recurrence and mortality. Among 210 patients (median age 68), 3‑year disease‑specific survival was 85%, but lesions ≥4 cm with perineural invasion and deep subcutaneous invasion identified a high‑risk group with 3‑year DSS of 70% versus 100% for patients without these factors.

Abstract

Purpose To identify nonmelanoma skin cancer patients with squamous cell carcinoma (SCC) who are at greatest risk of disease-specific mortality. Patients and Methods Prospectively enrolled patients with a minimum of one pathologically confirmed skin SCC lesion, definitive treatment of the SCC lesion(s) resulting in no evidence of disease, and at least 2 months of follow-up after definitive treatment were eligible for the present longitudinal analysis. They received comprehensive clinical, pathologic evaluations and follow-up for patterns of failure and mortality. Results We enrolled 210 patients (187 men and 23 women) with a total of 277 skin SCC lesions and a median enrollment age of 68 years (range, 34 to 95 years). Median follow-up of surviving patients was 22 months. Three-year overall and disease-specific survival (DSS) rates were 70% and 85%, respectively. In univariate analyses, the clinical-pathologic factors associated with adverse DSS were local recurrence at presentation (P = .05), invasion beyond subcutaneous tissues (P = .009), perineural invasion (P = .002), lesion size (P = .0003), and depth of invasion (P = .05). Statistical models identified a homogeneous high-risk group of patients with lesions ≥ 4 cm, perineural invasion, and deep invasion beyond subcutaneous structures. Three-year DSS was 100% for patients with no risk factors versus 70% for patients with at least one risk factor. Conclusion Lesion size ≥ 4 cm and histologic evidence of perineural invasion and deep invasion beyond subcutaneous structures were the clinical-pathologic factors most significantly associated with disease-specific mortality in skin SCC.