DS23 Risk stratification and surgical management of cutaneous squamous cell carcinoma: a single-centre real-world cohort study

Abstract

Cutaneous squamous cell carcinoma (cSCC) management follows BAD guidance, with risk-stratified treatment and follow-up informed by American Joint Committee on Cancer (AJCC) and Brigham and Women’s Hospital staging. Variation in treatment selection and follow-up persists, and real-world outcome data remain limited. A retrospective, single-centre cohort study was undertaken involving 245 patients diagnosed with cSCC in 2022. The study aimed to characterize patient, tumour, staging and management factors, and to evaluate recurrence, mortality and follow-up practices. The mean age at diagnosis was 79 years; 29% of patients were female, 71% were male and 15% were immunosuppressed. Following surgery, complete excision was achieved in 90% of cases. The overall recurrence rate was 6% (1% local, 4% regional, < 1% distant), consistent with published UK data. Published real-world data describing the proportion of cSCC by individual AJCC T stage and T-stage-stratified outcomes remain limited. In this cohort, 56% were AJCC T1, 18% T2, 16% T3 and 1% T4; 9% had no documented T stage. The median time to recurrence was 276 days (interquartile range 263–506), with 85% of recurrences occurring within 2 years and all within 3 years. Stratified by T stage, the median time to recurrence was 596 days for T1 tumours, 444 days for T2 tumours and 268 days for T3 tumours. Recurrence rates were 2% for T1 tumours, 7% for T2 tumours and 15% for T3 tumours. No recurrences were observed in T4 tumours, reflecting the small number of cases in this group. This large UK real-world cohort with prolonged follow-up provides novel data on AJCC T-stage distribution and T-stage-stratified outcomes in cSCC. Recurrence was uncommon, occurred predominantly within 2 years, and was associated with increasing T stage, supporting the prognostic relevance of AJCC staging. These findings support risk-stratified follow-up and suggest that follow-up intensity may be reduced for selected lower-risk cSCC.