What are the American College of Radiology (ACR) Appropriateness Criteria for the treatment of aggressive cutaneous squamous cell carcinoma (cSCC)?

Updated: Jul 08, 2020
  • Author: Talib Najjar, DMD, MDS, PhD; Chief Editor: Arlen D Meyers, MD, MBA  more...
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Answer

Appropriateness Criteria® for the treatment of aggressive nonmelanomatous skin cancer of the head and neck, issued by the American College of Radiology (ACR) in 2014, include the following recommendations [68] :

  • Cutaneous squamous cell cancer (cSCC) that is resected with negative margins and does not display high-risk features can be safely observed postoperatively
  • Consider adjuvant radiotherapy for resected SCC that demonstrates perineural invasion, especially multifocal; in cases of extensive perineural invasion or invasion of named nerves, the nerve should be targeted with radiotherapy back to the skull base
  • Patients with periparotid nodal disease should be managed by surgical resection with neck dissection, followed by adjuvant radiotherapy
  • Concurrent cisplatin-based chemotherapy can be considered in patients with high-risk pathologic features (eg, margin positivity or extracapsular extension) or in patients with unresectable, locally advanced disease
  • Intensified adjuvant therapies, such as radiotherapy for intermediate-risk patients and incorporating systemic therapies concurrently with radiotherapy, may benefit certain classes of patients

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