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Mortality Risk From Squamous Cell Skin Cancer

From the Departments of Head and Neck Surgery, Biostatistics and Applied Mathematics, Dermatology, Pathology, Epidemiology, Immunology, Thoracic/Head and Neck Medical Oncology, and Clinical Cancer Prevention, The University of Texas M.D. Anderson Cancer Center, Houston, TX

Address reprint requests to Gary L. Clayman, MD, The University of Texas M.D. Anderson Cancer Center, Department of Head and Neck Surgery, 1515 Holcombe Blvd, Unit 441, Houston, TX 77030-4009; e-mail: gclayman{at}mdanderson.org

PURPOSE: To identify nonmelanoma skin cancer patients with squamous cell carcinoma (SCC) who are at greatest risk of disease-specific mortality.

PATIENTS AND METHODS: Prospectively enrolled patients with a minimum of one pathologically confirmed skin SCC lesion, definitive treatment of the SCC lesion(s) resulting in no evidence of disease, and at least 2 months of follow-up after definitive treatment were eligible for the present longitudinal analysis. They received comprehensive clinical, pathologic evaluations and follow-up for patterns of failure and mortality.

RESULTS: We enrolled 210 patients (187 men and 23 women) with a total of 277 skin SCC lesions and a median enrollment age of 68 years (range, 34 to 95 years). Median follow-up of surviving patients was 22 months. Three-year overall and disease-specific survival (DSS) rates were 70% and 85%, respectively. In univariate analyses, the clinical-pathologic factors associated with adverse DSS were local recurrence at presentation (P = .05), invasion beyond subcutaneous tissues (P = .009), perineural invasion (P = .002), lesion size (P = .0003), and depth of invasion (P = .05). Statistical models identified a homogeneous high-risk group of patients with lesions 4 cm, perineural invasion, and deep invasion beyond subcutaneous structures. Three-year DSS was 100% for patients with no risk factors versus 70% for patients with at least one risk factor.

CONCLUSION: Lesion size 4 cm and histologic evidence of perineural invasion and deep invasion beyond subcutaneous structures were the clinical-pathologic factors most significantly associated with disease-specific mortality in skin SCC.

Supported in part by National Cancer Institute grant No. P01-5P01CA68233 (G.L.C.), grant No. CA97007, and Cancer Center Support Grant No. 5P30 CA16672.

G.L.C., J.J.L., and F.C.H. contributed equally to this work.

Authors' disclosures of potential conflicts of interest are found at the end of this article.

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