Tumor depth is associated with the highest risk of local recurrence and metastasis of cutaneous squamous cell carcinoma (cSCC), and tumor diameter more than 20 mm is associated with the highest risk of disease-specific death, according to a study published online ahead of print in JAMA Dermatology.1
Because there are limited data on the magnitude of association between risk factors and cSCC outcomes, researchers sought to systematically analyze all published data on risk factors for recurrence, metastasis, and disease-specific death of cSCC.
For the meta-analysis, researchers analyzed data from 36 studies that included 17 248 patients with a total of 23 421 cSCCs. Results showed that significant risk factors for recurrence included Breslow thickness exceeding 2 mm, invasion beyond subcutaneous fat, Breslow thickness exceeding 6 mm, perineural invasion, diameter exceeding 20 mm, location on the temple, and poor differentiation, listed in order from highest to lowest relative risk.
Researchers found that significant risk factors for metastasis were invasion beyond subcutaneous fat, Breslow thickness exceeding 2 mm, Breslow thickness exceeding 6 mm, diameter exceeding 20 mm, poor differentiation, perineural invasion, immunosuppression, and location on the temple, ear, or lip.
In regard to disease-specific death, significant risk factors were diameter exceeding 20 mm, poor differentiation, location on the ear or lip, invasion beyond subcutaneous fat, and perineural invasion.
Of note, evidence was considered to be of low to moderate quality.
“Unified, consistent collection and reporting of risk factors in a prospective, multicentered effort are needed to further understand the increasing incidence of cSCC,” the authors conclude.
1. Thompson AK, Kelley BF, Prokop LJ, et al. Risk factors for cutaneous squamous cell carcinoma recurrence, metastasis, and disease-specific death: A systematic review and meta-analysis [published online ahead of print January 13, 2016]. JAMA Dermatol. doi:10.1001/jamadermatol.2015.4994.