From the Guidelines
For a biopsy-confirmed squamous cell carcinoma (SCC) of the leg, further testing should include an ultrasound-guided FNA or surgical biopsy of regional lymph nodes if they are clinically palpable, as recommended by the British Journal of Dermatology study 1. When evaluating regional lymph nodes, it is essential to consider the potential for metastatic SCC. According to the study 1, if regional lymph nodes are clinically palpable, an ultrasound-guided FNA (or surgical biopsy if FNA results are inconclusive) should be performed to assess for the presence of SCC.
- If the lymph node biopsy is positive for metastatic SCC, regional lymph node dissection should be considered, which can usually be carried out at the time of surgical excision of the primary SCC, as suggested by the study 1.
- Sentinel lymph node biopsy (SLNB) may be undertaken, but its effectiveness in informing prognosis or influencing clinical outcome in patients with SCC is still unclear, as noted in the study 1.
- Regional lymph node clearance should be considered if there is evidence of nodal disease on FNA or biopsy, as it may reduce subsequent problems from ulceration and local complications of secondary tumor deposits, as recommended by the study 1. It is crucial to carefully evaluate and manage SCC of the leg, as it can be invasive and potentially metastasize if not properly managed, highlighting the importance of thorough testing and staging.
From the Research
Further Tests for Biopsy-Confirmed Squamous Cell Carcinoma of the Legs
- For patients with high-risk cutaneous squamous cell carcinoma (SCC), further tests such as sentinel lymph node biopsy (SLNB) may be necessary to determine the presence of subclinical lymph node metastasis 2, 3.
- SLNB has been shown to accurately diagnose subclinical lymph node metastasis with few false-negative results and low morbidity 2.
- The decision to perform SLNB should be based on the individual patient's risk factors and clinical context, as the utility of SLNB in SCC is still being investigated 2, 3.
- Other diagnostic imaging techniques such as dermoscopy and reflectance confocal microscopy may also be useful in the diagnosis and monitoring of SCC 4.
- For patients with SCC in situ of the lower extremity, treatment options such as local destruction, excision, or topical therapy may be effective, and patient-reported outcomes can be used to evaluate the success of these treatments 5.
Considerations for Sentinel Lymph Node Biopsy
- The false-negative rate and negative predictive value of SLNB may vary depending on the location of the tumor, with higher rates reported for tumors of the trunk and extremities compared to the head and neck 3.
- The use of SLNB in oral squamous cell carcinoma is also being investigated, with recent studies demonstrating its potential clinical utility 6.
- Factors such as depth of invasion, nodal mapping, histopathology methods, operator variability, and postoperative complications should be considered when deciding whether to perform SLNB 6.