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The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors
Author(s) -
Brougham Nicholas D.L.S.,
Dennett Elizabeth R.,
Cameron Rujuta,
Tan Swee T.
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23155
Subject(s) - medicine , lymphovascular invasion , perineural invasion , metastasis , oncology , pathology , cancer
Background Cutaneous squamous cell carcinoma (cSCC), the most common cancer capable of metastasis, has variable reported metastatic rates and the impact of individual risk factors for metastasis is unknown. Methods This study examined pathology records of excised cSCC over a 10‐year period. Uni‐variate and multi‐variate analyses including patient demographics, maximum clinical diameter (MCD), anatomical sub‐site, histological differentiation, perineural invasion (PNI), and lymphovascular invasion (LVI) of the lesion were performed. The primary endpoint was time to metastasis. Results Six thousand one hundred sixty four patients (median age 74 years) underwent excision of 8,997 primary cSCC. During the median follow‐up of 70 months, the metastatic rate of cSCC was 1.9–2.6%. Multi‐variate analysis showed that MCD (hazards ratio 1.41 [95% CI 1.25–1.60] P < 0.001), PNI (5.29; P < 0.0001), poor histological differentiation (4.26; P < 0.0001), location in the ear and retro‐auricular area (3.31 [1.17–9.33]; P = 0.0024), cheek (3.18 [1.15–8.81]; P = 0.026), and lip (4.84; P = 0.009) increased the risk of metastasis. Conclusions We show a 1.9–2.6% metastatic rate for cSCC with MCD, histologic differentiation, PNI, and certain anatomical sub‐sites being independent risk factors for metastasis. A prospective study on our proposed risk stratification scheme based on these parameters may lead to identification of high‐risk lesions that would benefit from more intensive treatment and/or routine post‐operative follow‐up. J. Surg. Oncol. 2012; 106:811–815. © 2012 Wiley Periodicals, Inc.