Risk factors and timing of subsequent cutaneous squamous cell carcinoma in patients with cutaneous squamous cell carcinoma: A retrospective cohort study

J Am Acad Dermatol. 2021 Mar;84(3):719-724. doi: 10.1016/j.jaad.2020.08.083. Epub 2020 Aug 27.

Abstract

Background: Information about the frequency and timing of subsequent cutaneous squamous cell carcinoma (cSCC), along with associated risk factors, is limited. However, this information is crucial to guide follow-up care for these patients.

Objective: To evaluate the risk and timing of subsequent cSCC in patients who presented with an initial diagnosis of cSCC.

Methods: Retrospective review of an institutional review board-approved, single-institution registry of invasive cSCC. All patients had at least 2 primary cSCCs diagnosed on 2 separate dates 2 months apart.

Results: A total of 299 primary cSCCs were included. At 6 months from initial cSCC diagnosis, 18.06% (n = 54) of patients developed subsequent cSCC; at 1 year, 31.77% (n = 94); at 3 years, 67.56% (n = 202); and at 5 years, 87.96% (n = 263) developed subsequent cSCC. Risk factors associated with subsequent cSCC include age at initial diagnosis (hazard ratio [HR], 1.02; 95% confidence interval, 1.004-1.027; P = .008), T2 stage (HR, 1.66; 95% CI, 1.07-2.57; P = .025), and poor tumor grade. Tumor grades well, moderate, and unknown have HRs of 0.21 (P < .001), 0.16 (P .001), and 0.25 (P = .001), respectively.

Conclusions: Of patients who develop subsequent cSCC, 18.06% do so within 6 months, and 31.77% do so within 1 year of initial cSCC diagnosis. Patients with advanced age, poor histologic differentiation, and American Joint Committee on Cancer T2 stage are at highest risk. Close clinical follow-up after the initial diagnosis is recommended.

Keywords: MMS; Mohs surgery; clinical research; cutaneous oncology; dermatologic surgery; full-body skin examination; general dermatology; medical dermatology; oncology; squamous cell carcinoma; total body skin examination.

MeSH terms

  • Age Factors
  • Aged
  • Aged, 80 and over
  • Carcinoma, Squamous Cell / diagnosis
  • Carcinoma, Squamous Cell / epidemiology*
  • Carcinoma, Squamous Cell / pathology
  • Electronic Health Records / statistics & numerical data
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Invasiveness
  • Neoplasm Staging
  • Neoplasms, Second Primary / diagnosis
  • Neoplasms, Second Primary / epidemiology*
  • Neoplasms, Second Primary / pathology
  • Retrospective Studies
  • Risk Factors
  • Skin / pathology*
  • Skin Neoplasms / diagnosis
  • Skin Neoplasms / epidemiology*
  • Skin Neoplasms / pathology
  • Time Factors