From the Guidelines
The patient with a well-differentiated Squamous Cell Carcinoma (SCC) lesion that has been excised with negative margins, no perineural or lymphovascular invasion, and clear deep and peripheral margins by 1.8 mm and 2.3 mm, respectively, has a favorable prognosis and does not require further surgical intervention at this time. The excision margins of 1.8 mm and 2.3 mm exceed the generally accepted minimum of 1 mm for low-risk squamous cell carcinoma, as suggested by guidelines of care for the management of cutaneous squamous cell carcinoma 1.
Key Considerations
- The patient should be scheduled for regular follow-up examinations every 3-6 months for the first two years, then annually for at least five years to monitor for recurrence or new lesions, as recommended by guidelines for the management of cutaneous squamous cell carcinoma 1.
- During follow-ups, thorough skin examinations should be performed, with particular attention to the excision site and regional lymph nodes.
- 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 and Follow-up
The favorable histological features (well-differentiated, negative margins, absence of perineural and lymphovascular invasion) suggest a good prognosis, as indicated by studies on the management of cutaneous squamous cell carcinoma 1. However, patients with a history of skin cancer have an increased risk of developing subsequent skin cancers, emphasizing the importance of regular follow-up and sun protection measures.
Recommendations
- Regular follow-up examinations to monitor for recurrence or new lesions.
- Patient education regarding sun protection measures.
- Thorough skin examinations during follow-ups, with particular attention to the excision site and regional lymph nodes.
From the Research
Prognosis for Well-Differentiated Squamous Cell Carcinoma
The prognosis for a patient with a well-differentiated Squamous Cell Carcinoma (SCC) lesion that has been excised with negative margins, no perineural or lymphovascular invasion, and clear deep and peripheral margins by 1.8 mm and 2.3 mm, respectively, is generally favorable.
- The study 2 found that the recurrence rate for well-differentiated SCC was 1.7%, with no recurrence occurring beyond a histopathologic margin of 3.5 mm.
- The same study 2 also found that the grade of differentiation and anatomic site had a larger influence on recurrence rates compared to the histopathologic margins.
- Another study 3 identified factors for high-risk cutaneous SCC, including large size, deeply invasive lesion, incomplete excision, high-grade/desmoplastic lesions, perineural invasion, lymphovascular invasion, immunosuppression, and high-risk anatomic locations.
- Since the patient's lesion does not exhibit any of these high-risk features, the prognosis is more favorable.
- However, it is essential to note that perineural invasion (PNI) is a significant factor in determining the prognosis of SCC, and its presence is associated with a poorer prognosis 4, 5, 6.
- In this case, the absence of PNI and other high-risk features suggests a better prognosis.