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J Am Acad Dermatol. 2018 Feb;78(2):249-261. doi: 10.1016/j.jaad.2017.08.058.

Cutaneous squamous cell carcinoma: Management of advanced and high-stage tumors.

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Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts. Electronic address:
Medstar Georgetown Melanoma and Skin Cancer Center, Georgetown University, Washington, DC.
Department of Dermatology, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.


While the majority of cutaneous squamous cell carcinomas (cSCCs) can be treated surgically, the additional work-up and treatments indicated for high-risk cSCC remain undefined. In recent years, improvements in tumor staging systems have allowed for the more accurate stratification of tumors into high- and low-risk categories. This insight, along with the publication of cSCC guidelines, brings us closer to the development of a consensus approach. The second article in this continuing medical education series addresses in question and answer format the most common questions related to advanced and high-stage cSCCs, with a simplified flowchart. The questions include the following: 1) Does my patient have high-risk cSCC?; 2) What is the next step for patients with cSCC and palpable lymphadenopathy?; 3) In patients with no clinically evident lymphadenopathy, who are candidates for lymph node staging?; 4) What forms of radiologic imaging can help detect subclinical lymph node metastases?; 5) What is the role of sentinel lymph node biopsy in cSCC?; 6) Which patients with cSCC need adjuvant radiation therapy?; 7) Is adjuvant chemotherapy an option for patients with high-stage cSCC after surgery?; 8) Are targeted and immunologic therapies an option for advanced cSCC?; 9) How often should I follow up with my patient after he/she has been diagnosed with a high-risk cSCC?; 10) What are the options for chemoprophylaxis in a patient with an increased risk of cSCC?; and 11) What chemopreventive measures can be started in coordination with medical oncology or transplant physicians?


5-fluorouracil; American Joint Commission on Cancer; Brigham and Women's Hospital staging system; CDKN2A; CT; MRI; N1S3 staging; NOTCH1; PD-1; Ras; acitretin; cSCC; capecitabine; cetuximab; chemotherapy; classification; cutaneous squamous cell carcinoma; familial cancer syndromes; high-risk; imiquimod; ingenol mebutate; management; nicotinamide; nivolumab; p53; pembrolizumab; photodynamic therapy; radiation therapy; retinoids; risk factors; sentinel lymph node biopsy; sirolimus; staging

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