Evaluation for locoregional and distant metastases in cutaneous squamous cell and basal cell carcinoma
- Allison Vidimos, MD
Allison Vidimos, MD
- Chairman, Department of Dermatology
- Vice Chairman, Dermatology and Plastic Surgery Institute
- Cleveland Clinic
- Todd Stultz, DDS, MD
Todd Stultz, DDS, MD
- Staff, Section of Neuroradiology
- Imaging Institute
- Cleveland Clinic
In the majority of patients with cutaneous squamous cell carcinoma (SCC) or basal cell carcinoma (BCC), disease remains limited to the skin and is successfully managed with local therapy, such as excision, lesion destruction, or irradiation of the primary lesion. However, in 1 to 5 percent of patients with cutaneous SCC and in rare individuals with BCC, locoregional or distant metastases occur, resulting in an increased risk for mortality and the need for alternative approaches to therapy. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence", section on 'Metastasis' and "Treatment and prognosis of cutaneous squamous cell carcinoma", section on 'Prognosis'.)
The evaluation for regional and distant metastases in patients with cutaneous SCC or BCC will be reviewed here. The clinical features and treatment of SCC and BCC are discussed elsewhere. (See "Clinical features and diagnosis of cutaneous squamous cell carcinoma (SCC)" and "Treatment and prognosis of cutaneous squamous cell carcinoma" and "Epidemiology, pathogenesis, and clinical features of basal cell carcinoma" and "Treatment and prognosis of basal cell carcinoma at low risk of recurrence" and "Treatment of basal cell carcinomas at high risk for recurrence".)
SQUAMOUS CELL CARCINOMA
The identification of patients at increased risk for metastasis and, concordantly, the most appropriate work-up for metastatic disease are important components of the management of patients with cutaneous SCC . However, data on the approach to the evaluation for metastatic disease are limited, contributing to the absence of definitive recommendations on the indications for investigative tests and the selection of appropriate studies.
In general, clinical assessment by physical examination is considered sufficient for the evaluation of most patients with cutaneous SCC; the need for further evaluation with radiologic studies should be considered in patients who exhibit clinical or pathologic features associated with an elevated risk for metastasis (high-risk SCC) (table 1). The impact of sentinel lymph node (SLN) biopsy, which has been used to evaluate lymph node status in select patients with high-risk SCC, remains uncertain. (See 'Patients without palpable lymph nodes' below and 'Evaluation for distant metastases' below and 'Sentinel lymph node biopsy' below.)
Locoregional evaluation — Lymph nodes are the most common sites for metastasis of cutaneous SCC, and, regardless of the presence or absence of high-risk features (table 1), all patients diagnosed with invasive cutaneous SCC should undergo regional lymph node palpation at the time of diagnosis and during post-treatment follow-up. (See "Treatment and prognosis of cutaneous squamous cell carcinoma", section on 'Follow-up'.)
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- SQUAMOUS CELL CARCINOMA
- Locoregional evaluation
- - Patients with palpable lymph nodes
- - Patients without palpable lymph nodes
- - Choice of radiologic study
- Computed tomography and magnetic resonance imaging
- Positron emission tomography
- Evaluation for distant metastases
- Sentinel lymph node biopsy
- BASAL CELL CARCINOMA
- SUMMARY AND RECOMMENDATIONS