Multiple Cutaneous Squamous Cell Carcinoma Raises Risk of Recurrence, Metastasis

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Patients with multiple cutaneous squamous cell carcinomas (CSCCs), especially those with 10 or more, have an elevated risk of local recurrence (LR) and nodal metastases (NM) compared to those with one CSCC, according to an article published online in the journal JAMA Dermatology.

The authors of this study analyzed electronic medical records of patients diagnosed with dermally invasive (non-in situ) primary CSCC between January 1, 2000, and December 31, 2009. The medical records were used to determine Brigham and Women’s Hospital tumor stage and outcomes such as LR, NM, and death due to CSCC.

A total of 985 patients were evaluated: 727 with 1 CSCC, 239 with 2 to 9 CSCCs, and 19 with 10 or more CSCCs. Most patients with 10 or more CSCCs (15 out of 19; 78.9%) were determined to be immunosuppressed.

Compared to patients with one CSCC, those with more than one had an increased risk of LR (subhazard ratio for 2-9 CSCCs, 1.8; 95% CI: 1.1, 4.3; and for ≥10 CSCCs, 3.8; 95% CI: 1.4, 10.0) and NM (subhazard ratio for 2-9 CSCCs, 3.0; 95% CI: 1.4, 6.5; and for ≥10 CSCCs, 4.2; 95% CI: 1.4, 10.4).

Patients with 10 or more CSCCs had a significantly higher 10-year cumulative incidence of LR and NM (LR, 36.8%; 95% CI: 19.2%, 59.0%; and NM, 26.3%; 95% CI: 11.8%, 48.8%) compared to the patients with two to nine CSCCs ( LR, 6.7%; 95% CI: 4.2%, 10.6%; and NM, 5.9%; 95% CI: 3.5%, 9.6%) and 1 CSCC (LR, 3.0%; 95% CI: 2.0%, 4.5%; and NM, 2.3%; 95% CI: 1.5%, 3.8%).

Electron micrograph of a human plasma cell from bone marrow in multiple myeloma / Phototake
Patients with multiple cutaneous squamous cell carcinomas have elevated risk of local recurrence and nodal metastases.
Patients with multiple cutaneous squamous cell carcinomas (CSCCs) pose a management challenge for physicians, but their prognosis is unknown because outcomes have not been compared between patients who form single vs multiple CSCCs. Objective To compare outcomes in patients with 1 vs multiple CSCCs.
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