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Factors Affecting Survival for Patients with Advanced Cutaneous Squamous Cell Carcinoma

By: Lauren Harrison, MS
Posted: Wednesday, June 12, 2019

Patients with advanced cutaneous squamous cell carcinoma of the head and neck tend to have worse outcomes if their disease is present at an anatomic subsite, specifically scalp and neck tumors. In addition, positive final margins were also linked to worse prognosis in this patient population. Christopher Blake Sullivan, MD, of the University of Iowa Hospitals and Clinics, Iowa City, and colleagues described survival outcomes for patients with T3 or T4 cutaneous squamous cell carcinoma of the head or neck in the Annals of Otology, Rhinology, & Laryngology.

The research team identified a total of 43 patients with T3 or T4 cutaneous squamous cell carcinoma of the head and neck treated at the University of Iowa Hospitals and Clinics from 2005 to 2016. Of those who had a history of head and neck skin cancer, 33 patients had prior surgical resection, and 11 were treated with radiation therapy. More than half (58%) of these patients were treated with radical resection, consisting of temporal bone resection, orbital exenteration, calvarial resection, mandibulectomy, or maxillectomy. Surgical margins were positive in 44.2% of cases.

As for outcomes, patients who had positive surgical margins had worse recurrence-free and overall survival, although the results were not statistically significant. The 1-year survival probability for patients with tumors of the scalp/neck was 85.7%. After neck dissection, this survival probability rose to over 93%. For ear, face, and eyelid primary squamous cell carcinomas, the 1-year survival probability was 94.1%, 90.0%, and 100%, respectively.

The type of surgical resection did not seem to impact outcomes, with survival and recurrence similar among those who had radical surgical resection compared with those who had soft-tissue resection alone. Also, patients who were immunosuppressed tended to have worse survival, although this finding was not statistically significant. Patient age, perineural invasion, lymphovascular invasion, and disease stage all did not significantly affect survival outcomes.

Disclosure: The study authors reported no conflicts of interest.



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