Track

Clinical Studies

Abstract

Three are approximately 15,000 yearly deaths from cutaneous squamous cell carcinomas (cSCC) each year in the United States, twice as many as melanoma. Factors predicting cSCC progression are not well-defined, and pathological reporting of cSCC characteristics remain variable. We studied surface ulceration as an independent factor in cSCC progression. We examined 3 cohorts of patients diagnosed with cSCC from two institutions, totaling 296 patients. One cohort was composed of aggressive cSCC (68 cases), defined as BWH tumor stage T2b or T3. The other two cohorts were primary invasive cSCC that went on to metastasize (cohort A: 21 cases; cohort B: 38 cases). Matched controls were invasive cSCC without aggressive features matched by age, sex, and tumor site. Cases and controls were blinded and ulceration status was reviewed by 3 pathology residents, with discrepancies adjudicated by a board-certified dermatopathologist. In the aggressive cohort, 41 (60.3%) of the cases were ulcerated; while 7 (10.1%) of the controls were ulcerated (p<0.001). In metastatic cohort A, 12 (57.1%) of the cases were ulcerated; 2 (4.9%) of the controls were ulcerated (p<0.001). In metastatic cohort B, 24 (63.1%) of the cases were ulcerated; 20 (33.9%) of the controls were ulcerated (p=0.0047). Presence of ulceration was statistically significant in cSCCs with aggressive features and that subsequently metastasized in our cohorts, suggesting ulceration is predictive of aggressive cSCC behavior both locally and systemically. We propose that ulceration be reported for aggressive BWH tumor stage T2b or T3 cSCC in pathology reports.