Validation of the 2022 National Comprehensive Cancer Network Risk Stratification for Cutaneous Squamous Cell Carcinoma

• DOI: 10.1001/jamadermatol.2023.1353
• Publication Date: 2023-06-07T15:09:09Z
• Authors: Jacqueline S. Ste...; Fadi Murad; Timothy D. Smile; Daniel M. O’Connor; Evelyn Ilori; Shlomo Koyfman; Allison Vidimos; Abigail B. Waldman; Emily S. Ruiz
• Keywords: Mohs surgery; Risk Stratification

Importance The 2022 National Comprehensive Cancer Network (NCCN) reclassified cutaneous squamous cell carcinoma (CSCC) into low-, high-, and very high-risk groups to better risk stratify tumors. Mohs micrographic surgery (Mohs) or peripheral deep en face margin assessment (PDEMA) became preferred surgical modalities for high- This new stratification the recommendation PDEMA in have not been validated. Objective To compare outcomes low-risk NCCN of CSCCs treated with compared wide local excision (WLE). Design, Setting, Participants retrospective cohort study was performed 2 tertiary care academic medical centers. Patients 18 years older diagnosed between January 1, 1996, December 31, 2019, at Brigham Women’s Hospital Cleveland Clinic Foundation were included. Data analyzed from October 20, 2021, March 29, 2023. Exposures group, PDEMA, WLE. Main Outcomes Measures Local recurrence (LR), nodal metastasis (NM), distant (DM), disease-specific death (DSD). Results A total 10 196 tumors 8727 patients stratified by guidelines (6003 [59.0%] men; mean [SD] age, 72.4 [11.8] years). Compared demonstrated a greater LR (high-risk subhazard ratio [SHR], 1.99 [95% CI, 1.21-3.27; P = .007]; SHR, 12.66 7.86-20.39; < .001]), NM 4.26 1.28-14.23; .02]; 62.98 19.24-206.17; DM 2.2 × 7 4.7 3 -1.1 11 ; .001]; 6.3 8 1.4 5 -2.9 12 DSD 4.02 1.18-13.71; .03]; 93.87 29.19-301.85; .001]). Adjusted 5-year cumulative incidence significantly higher vs (9.4% 9.2%-14.0%] 1.5% 1.4%-2.1%] 0.8% 0.5%-1.2%], respectively), (7.3% 6.8%-10.9%] 0.5% 0.4%-0.8%] 0.1% 0.03%-0.3%], (3.9% 2.6%-5.6%] 0.04%-0.2%] 0.01% applicable], (10.5% 10.3%-15.4%] 0.04%-0.3%], respectively). WLE, those had lower (SHR, 0.65 0.46-0.90]; .009), 0.38 0.18-0.83]; .02), 0.55 0.36-0.84]; .006). Conclusions Relevance findings this suggest that identify greatest developing poor outcomes. Further, resulted LR, DM,