Abstract

Background: Ulceration is important in the prognosis of melanoma. We evaluated tumor ulceration in cutaneous squamous cell carcinoma (CSSS) in head and neck to other histological features and prognosis. Methods: After IRB approval, data collection and analysis were performed on 57 CSSS cases of head and neck, including 30 cases from the ear, from 2011 to 2020 from the archive of pathology department. The definition of melanoma ulceration and extent of ulceration were used. Results: 24 patients had ulceration with statistically significant T stage (ulcerated 75% T3, non-ulcerated (NU) 88% T1), size (ulcerated average size 3.31 cm, NU average size 0.89 cm), and depth of invasion (83% ulcerated >4mm, 69% NU ≤4 mm) (p-value= 0.00, 0.00, 0.001 respectively), lymphovascular invasion (29% in ulcerated, 9% in NU, p-value=0.05) and presence of desmoplasia (67% ulcerated, 22% NU, p-value= 0.01). There was a difference in ulceration when comparing ear to non-ear, 82% of ear showing >50% ulceration (p-value = 0.03) vs 69% of non-ear cases showed <50% ulceration. Ulceration vs non-ulceration did not show a difference in progression free or overall survival. Conclusion: Even though ulceration did not affect the prognosis, the T stage, size and depth of invasion showed a difference. Ulceration in CSSS might be present because of sun damage rather than tumoral mechanism/vascular growth as in melanoma since it was seen more in sun exposed ear. This also further substantiates the lack of ulceration’s effect on survival. Our data lays the groundwork for further studies evaluating tumor ulceration in CSSS.