What is the diagnosis and prognosis for a patient with a suspicious lesion on the right chest, where an excision was performed and pathology revealed invasive squamous cell carcinoma with negative resection margins, no lymphovascular or perineural invasion, and clear margins of 4mm deep and 5mm peripheral?

From the Guidelines

The patient's diagnosis is invasive squamous cell carcinoma with a favorable prognosis due to negative resection margins, no lymphovascular or perineural invasion, and clear margins of 4mm deep and 5mm peripheral, which exceeds the recommended margins of 4-6mm for low-risk cSCC 1. The pathology report indicates a well-differentiated invasive squamous cell carcinoma on the right chest with negative resection margins. Given these favorable findings, no further surgical intervention is necessary at this time.

Key Findings

• The margins are adequate with the deep margin cleared by 4 mm and the peripheral margin by 5 mm, which exceeds the generally accepted minimum of 2 mm for high-risk cutaneous squamous cell carcinoma.
• The absence of lymphovascular and perineural invasion is reassuring as these features would indicate a higher risk for metastasis.

Recommendations

• Regular follow-up examinations are recommended every 3-6 months for the first 2 years, then every 6-12 months for years 3-5, to monitor for local recurrence or new skin cancers.
• During these visits, a complete skin examination and palpation of regional lymph nodes should be performed.
• Patient education regarding sun protection is essential, including daily use of broad-spectrum sunscreen (SPF 30+), wearing protective clothing, and avoiding peak sun hours.

Prognosis

• The favorable histologic features in this case suggest a good prognosis, but continued surveillance remains important as patients with a history of skin cancer have an increased risk of developing subsequent skin malignancies, as noted in the guidelines of care for the management of cutaneous squamous cell carcinoma 1.

From the Research

Diagnosis and Prognosis

• The patient's diagnosis is invasive squamous cell carcinoma (SCC) with negative resection margins, no lymphovascular or perineural invasion, and clear margins of 4mm deep and 5mm peripheral 2.
• The prognosis for the patient is generally favorable, given the negative resection margins and lack of high-risk pathological features such as perineural invasion or lymphovascular invasion 3, 4.
• However, the patient's tumor was found to be invasive, which increases the risk of recurrence and metastasis compared to in situ tumors 2, 5.

Risk Factors and Recurrence Rates

• The patient's tumor does not have any high-risk pathological features such as perineural invasion, lymphovascular invasion, or close/positive margins, which reduces the risk of recurrence and metastasis 2, 3.
• The recurrence rate for well-differentiated SCC with clear margins is generally low, ranging from 1.0% to 1.7% 6.
• The anatomic site of the tumor, in this case, the right chest, is not typically considered a high-risk site for recurrence, unlike the lip or ear 6.

Management and Follow-up

• The patient's treatment with surgical excision and clear margins is consistent with current guidelines for the management of invasive SCC 2, 3.
• Follow-up is recommended to monitor for recurrence and metastasis, although the optimal follow-up schedule is not well-established and should be individualized based on the patient's risk factors and tumor characteristics 2, 3.