Skin Cancer Outcomes Worsen With Rise in Risk Factors

TOPLINE:

Poor outcomes in patients with cutaneous squamous cell carcinoma (CSCC) were more likely if they had additional risk factors, a multinational study found.

METHODOLOGY:

• A retrospective cohort study evaluated 16,844 patients (median age, 73.9 years; 64.5% men) with CSCCs from 12 centers in the United States, Spain, and Brazil.
• Researchers stratified tumors by the number of risk factors: Diameter ≥ 2 cm, poorly differentiated histology, tumor extension beyond subcutaneous fat, and large-caliber nerve invasion.
• Most CSCCs had no risk factors (75.1%), and group size decreased as risk factors increased by 1 (17.2%), 2 (6.0%), 3 (1.3%), and 4 (0.3%).
• Outcomes were local recurrence, nodal metastasis, distant metastasis, and disease-specific death, with a median follow-up of 33.6 months.

TAKEAWAY:

• Five-year local recurrence rates rose from 1.7% to 33% for 0 vs 4 risk factors and from 0.6% to 28.0% for nodal metastasis, 0.2% to 8.4% for distant metastasis, and 0.3% to 25.0% for disease-specific death.
• For each outcome, the estimated 5-year risk rose with each additional risk factor.
• The risk for local recurrence was significantly higher for tumors with 0 vs one (adjusted subdistribution hazard ratio [SHR], 2.98; P < .001), one vs two (SHR, 1.54; P = .01), two vs three (SHR, 1.65; P = .02), and three vs four risk factors (SHR, 2.04; P = .03).
• The risks for nodal metastasis, distant metastasis, and disease-specific death increased for 0 vs one (SHR, 6.23, 6.93, and 5.63, respectively), one vs two (SHR, 2.60, 2.13, and 2.44, respectively), and two vs three (SHR, 1.72, 3.46, and 1.93, respectively) risk factors (all P ≤ .05).
• The risks for local recurrence, nodal metastasis, distant metastasis, and disease-specific death increased as risk factors rose.

IN PRACTICE:

“In this multicenter, multinational cohort study of 16,844 CSCCs, the number of RFs was associated with the risk of recurrence, metastasis, and death,” the authors wrote. “Considering the number of risk factors, not just tumor stage, may aid in clinical decision-making,” they added.

SOURCE:

The study was led by Nina A. Ran, MD, MS, Department of Dermatology, Brigham and Women’s Hospital in Boston. It was published online on March 19 in JAMA Dermatology.

LIMITATIONS:

The study lacked confirmation of risk factors for each tumor, and risk factors were assumed to be absent if no documentation was provided. Higher-risk tumors were overrepresented and more frequently imaged, which may have led to detection bias.

DISCLOSURES:

The study was supported by the American College of Mohs Surgery Foundation. Some authors reported receiving grants, honoraria, travel support, payment, or personal fees from multiple organizations, including Regeneron, Kyowa, and Eli Lilly and Company. One author held patents for machine learning models. Additional disclosures are noted in the original article.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.