From the Guidelines
Squamous cell carcinoma of the thigh should be treated with standard excision with a 4- to 6-mm margin of uninvolved skin around the tumor and/or biopsy site to a depth of the mid-subcutaneous adipose tissue with histologic margin assessment for low-risk primary cSCC. This approach is based on the guidelines of care for the management of cutaneous squamous cell carcinoma, as outlined in the Journal of the American Academy of Dermatology 1. The recommended margins are supported by a systematic review of observational studies, which reported an average local recurrence rate of 5.4% with excision margins ranging from 2 to 10 mm 1.
Key considerations for treatment include:
- Tumor size and depth, with larger or more aggressive tumors potentially requiring wider margins or alternative treatments such as Mohs micrographic surgery
- Histologic grade and risk stratification, with high-risk lesions requiring more cautious management and consideration of additional treatments such as radiation therapy
- The need for complete margin assessment to ensure removal of all cancerous tissue, particularly for high-risk tumors
- The importance of regular follow-up examinations to monitor for recurrence and development of new skin cancers, as patients with one squamous cell carcinoma have a 30-50% risk of developing another skin cancer within five years.
In terms of specific treatment approaches, standard excision with a 4- to 6-mm margin is recommended for low-risk primary cSCC, while Mohs micrographic surgery may be considered for high-risk tumors to ensure complete removal while preserving healthy tissue 1. Following surgery, the wound may be closed directly, with a skin graft, or allowed to heal by secondary intention depending on the defect size. Additional treatments such as radiation therapy may be considered for large tumors, those with perineural invasion, or in cases where surgery isn't feasible. Lymph node evaluation is necessary if there's clinical suspicion of metastasis. After treatment, regular follow-up examinations are essential, typically every 3-6 months for the first two years, then annually. Sun protection with broad-spectrum sunscreen, protective clothing, and avoiding peak UV hours is crucial to prevent recurrence.
From the Research
Squamous Cell Carcinoma of the Thigh
- Squamous cell carcinoma (SCC) is a type of skin cancer that can occur on various parts of the body, including the thigh 2.
- The diagnosis and treatment of SCC typically involve histopathology and surgical excision, with new diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy increasing diagnostic accuracy 2.
- Radiation therapy (RT) can be used as a definitive treatment for low-risk tumors or as adjuvant/salvage treatment for high-risk tumors, with a systematic review showing pooled local control and local recurrence rates of 87.3% and 8.6%, respectively 3.
Treatment Options
- Combination chemotherapy consisting of cisplatin, 5-fluorouracil, and bleomycin has been shown to be effective in treating advanced SCC of the skin, with an objective response rate of 84% and a complete remission rate of 30% 4.
- Definitive and postoperative RT can be used to treat basal cell carcinoma and cutaneous squamous cell carcinoma, with recommendations based on a systematic literature review and consensus-building methodology 5.
- A combination of radiation and chemotherapy has been used to treat advanced squamous carcinoma of the vulva, with a response rate of 92% and a complete response rate of 64% 6.
Considerations
- The choice of treatment for SCC of the thigh depends on various factors, including the stage and location of the tumor, as well as the patient's overall health and preferences 2, 3.
- Radiation therapy can be used to reduce tumor mass and facilitate definitive treatment, with the goal of achieving better functional and cosmetic results 4, 5.
- Combination chemotherapy and radiation therapy can be effective in treating advanced SCC, but may be associated with significant side effects and complications 4, 6.