According to the Scottish Intercollegiate Guidelines Network (SIGN) what are the high-risk clinical features of 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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Recommendations from the Scottish Intercollegiate Guidelines Network's (SIGN's) updated guidelines for the management of primary cutaneous squamous cell carcinoma (cSCC), published in 2014, are summarized below. [69]  

The following are considered high-risk clinical features [69] :

  • Immunosuppression
  • Ear as the tumor site
  • Horizontal tumor diameter of >20 mm 
  • Tumor depth >4 mm; >6 mm indicates a very–high-risk tumor
  • Tumor extension beyond the dermis into or through subcutaneous fat 
  • Perineural invasion
  • Desmoplastic subtype 
  • Poorly differentiated tumor status 

The presence of any of the above high-risk features in a patient with primary SCC warrants discussion of the patient in a multidisciplinary team (MDT) meeting.

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