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Toward a Better Definition of High-Risk Cutaneous Squamous Cell Carcinoma Comment on “Factors Predictive of Recurrence and Death From Cutaneous Squamous Cell Carcinoma”

Fiona Zwald, MD
JAMA Dermatol. 2013;149(5):547-548. doi:10.1001/jamadermatol.2013.24.
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Patient prognosis varies considerably among various types of skin cancer. Approximately 5% of cutaneous squamous cell carcinomas (CSCCs) metastasize, usually to regional nodes.1 A recent staging system has been developed for CSCC that combines tumor diameter with high-risk features, including primary tumor size greater than 2 cm, Breslow thickness greater than 2 mm, Clark level IV or greater, perineural invasion, poor differentiation, and primary site on the ear or lip, to classify tumors as T1 or T2. These high-risk factors have prognostic significance, particularly among immunocompromised patients. Immunosuppression contributes negatively to the prognosis and outcome of patients with CSCC; however, because strict TNM criteria exclude clinical risk factors in staging, immunosuppression was not included in the staging system.

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