What are the Scottish Intercollegiate Guidelines Network (SIGN) and Dermatological Cooperative Oncology Group treatment recommendations for squamous cell carcinoma (SCC)?

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

Scottish Intercollegiate Guidelines Network (SIGN)

SCC treatment options include the following [69] :

  • Surgical excision for high-risk tumors - A clinical peripheral margin of 6 mm or greater is indicated when surgically achievable and clinically appropriate
  • Surgical excision for low-risk tumors - A clinical peripheral margin of 4 mm or greater is indicated when surgically achievable and clinically appropriate
  • Mohs micrographic surgery should be considered for selected patients with high-risk tumors when tissue preservation or margin control is challenging, as well as for patients with any tumor at a critical anatomic site
  • Consider curettage and cautery for patients with low-risk tumors if healthcare professionals have had appropriate training with a blunt curette
  • Photodynamic therapy should not be used for treatment of primary SSC
  • Consider primary radiotherapy for patients if surgical excision would be extremely challenging or difficult to perform or would be likely to result in an unacceptable functional or aesthetic outcome
  • Consider adjuvant radiotherapy for patients with a high risk of local recurrence or with close or involved margins when further surgery carries an increased risk of complications, including functional or aesthetic morbidity

For patients with SCC with any high-risk features, posttreatment follow-up appointments every 3-6 months for 24 months should be offered. Depending on the clinical risk, it may be appropriate to also schedule one 3-year follow-up appointment. [69]

Dermatological Cooperative Oncology Group

Guidelines on cutaneous squamous cell carcinoma (cSCC) from the Dermatological Cooperative Oncology Group of the German Cancer Society and the German Society of Dermatology were published in April 2020. They include the following. [70]

Because data are insufficient regarding the value of regional lymphadenectomy following positive sentinel lymph node biopsy (SLNB), do not perform prophylactic lymphadenectomy.

When lymph node metastasis is clinically manifested, the patient should undergo regional (therapeutic) lymphadenectomy.

When local disease is inoperable or not completely resectable, radiation therapy should be performed.

The following cases should prompt use of postoperative radiation therapy:

  • R1 or R2 resection (if reexcision is not feasible)
  • Extensive lymph node involvement (>1 affected lymph node, lymph node metastasis >3 cm, capsular penetration)
  • Intraparotid lymph node involvement

Existence of the following risk factors should prompt treatment with adjuvant radiation therapy:

  • Surgical margins < 2 mm and reexcision is not feasible
  • Extensive perineural infiltration

Employ micrographically controlled surgery (MCS) for the treatment of local or locoregional recurrence.

If, over the course of the resection, residual, unresectable tumor tissue (R1 or R2 resection) is in evidence, the affected area should undergo radiation therapy.

If an interdisciplinary tumor board determines inoperability, radiation therapy should be performed.


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