Experts Show Lack of Consistency in High-Risk SCC

Findings in Mohs surgeons on managing squamous cell carcinoma suggest need for research

WEDNESDAY, Nov. 17 (HealthDay News) -- Mohs surgeons show a lack of consistency regarding indications for radiologic nodal staging (RNS) and adjuvant radiation therapy (ART) in high-risk cutaneous squamous cell carcinoma (HRCSCC), suggesting a need for clinical trials, according to research published in the November issue of the Archives of Dermatology.

Anokhi Jambusaria-Pahlajani, M.D., of the University of Pennsylvania in Philadelphia, and colleagues analyzed data from surveys of 117 and 118 members of the American College of Mohs Surgery regarding management of HRCSCC or SCC with perineural invasion (PNI), respectively.

The researchers found that most surgeons pointed to PNI and satellite or in-transit metastasis as top reasons to consider RNS, sentinel lymph node biopsy, or ART. They showed no other consensus for the use of or indications for these approaches. The authors suggest that clinical trials are needed, as there is no clear standard of care.

"There is a problematic practice gap in the treatment of aggressive cSCC. Dermatologists are best positioned to initiate collaborative studies with other specialists to find answers," writes the author of one accompanying editorial. The author of a second editorial adds that, "better care for our patients with advanced cSCC will come about through the performance of well-designed clinical trials. Jambusaria-Pahlajani et al have nicely documented the current uncertainty surrounding the care of these tumors, resulting in clinical equipoise, as well as the ethical basis that is present for performing these important clinical studies in the future."

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