Managing Cutaneous Squamous Cell Carcinoma

An updated evidence-based review outlines contemporary strategies for evaluating and managing cutaneous squamous cell carcinoma (cSCC), emphasizing the importance of risk stratification to guide treatment intensity.

Although most cSCCs are low risk and effectively managed with surgical excision alone, a subset of tumors are associated with an elevated risk of recurrence, metastasis, or death. Accurate identification of these high-risk tumors is critical to optimizing outcomes.

“Proper risk stratification of cSCCs can guide treatment decisions and management,” the authors wrote, “and identify those tumors that may benefit from more aggressive therapy.”

The review details a practical approach to lesion evaluation, incorporating clinical assessment, histologic features, and emerging prognostic tools. Risk classification should consider factors such as tumor diameter, depth of invasion, degree of differentiation, perineural involvement, and anatomic location.

Advanced imaging and sentinel lymph node biopsy may be warranted in select high-risk cases.

Treatment recommendations are stratified by risk. Low-risk tumors may be managed with standard excision or electrosurgery. High-risk tumors often require wider excision margins, adjuvant radiation, or multidisciplinary care, particularly in cases of perineural invasion or regional nodal spread.

The review also highlights the utility of newer prognostic tools, including gene expression profiling, in refining risk assessments. These tools may help predict metastasis and guide surveillance intensity or treatment escalation.

As incidence of cSCC continues to rise, integrating standardized risk assessment into routine practice remains essential. These updated strategies aim to support dermatologists and multidisciplinary teams in delivering personalized, risk-adapted care for patients with cSCC.

Reference
Trager MH, Gordon ER, Breneman A, et al. Management of cutaneous squamous cell carcinoma: A literature review and update. J Am Acad Dermatol. 2025;S0190-9622(25)03246-3. doi:10.1016/j.jaad.2025.11.043