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

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.