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Journal of Skin Cancer
Volume 2014, Article ID 154340, 8 pages
http://dx.doi.org/10.1155/2014/154340
Research Article

Evaluation of the Definitions of “High-Risk” Cutaneous Squamous Cell Carcinoma Using the American Joint Committee on Cancer Staging Criteria and National Comprehensive Cancer Network Guidelines

1Department of Dermatology, Saint Louis University, 1402 S. Grand Boulevard, 4th Floor, St. Louis, MO 63104, USA
2Stony Brook School of Medicine, Department of Dermatology, 181 N. Belle Mead Road, Suite 5, East Setauket, NY 11733, USA
3School of Medicine, Saint Louis University, 1402 S. Grand Boulevard, St. Louis, MO 63104, USA
4Center for Outcomes Research, Saint Louis University, 3545 Lafayette Avenue, 4th Floor, St. Louis, MO 63110, USA
5Department of Otolaryngology-Head and Neck Surgery, Saint Louis University, 3635 Vista Avenue, St. Louis, MO 63110, USA

Received 28 May 2014; Revised 1 September 2014; Accepted 2 September 2014; Published 17 September 2014

Academic Editor: Günther Hofbauer

Copyright © 2014 Melinda B. Chu et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Recent guidelines from the American Joint Committee on Cancer (AJCC) and National Comprehensive Cancer Network (NCCN) have been proposed for the assessment of “high-risk” cutaneous squamous cell carcinomas (cSCCs). Though different in perspective, both guidelines share the common goals of trying to identify “high-risk” cSCCs and improving patient outcomes. Thus, in theory, both definitions should identify a similar proportion of “high-risk” tumors. We sought to evaluate the AJCC and NCCN definitions of “high-risk” cSCCs and to assess their concordance. Methods. A retrospective review of head and neck cSCCs seen by an academic dermatology department from July 2010 to November 2011 was performed. Results. By AJCC criteria, most tumors (%) were of Stage 1; 46 tumors (13.9%) were of Stage 2. Almost all were of Stage 2 due to size alone (≥2 cm); one tumor was “upstaged” due to “high-risk features.” Using the NCCN taxonomy, 231 (87%) of tumors were “high-risk.” Discussion. This analysis demonstrates discordance between AJCC and NCCN definitions of “high-risk” cSCC. Few cSCCs are of Stage 2 by AJCC criteria, while most are “high-risk” by the NCCN guidelines. While the current guidelines represent significant progress, further studies are needed to generate a unified definition of “high-risk” cSCC to optimize management.