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Skin Cancer 2019: Recurrence and Staging of Cutaneous Squamous Cell Carcinoma After Mohs Surgery

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Key Points

  • Poor differentiation histology, solid organ transplantation recipient, comorbidity of diabetes mellitus, history of other malignancy, and trauma history on the site of cutaneous squamous cell carcinoma were high-risk factors for recurrence.
  • Among four staging systems, the AJCC 8th staging system showed the highest predictive value.
  • Immunohistochemical staining results showed that MFN-2 expression was higher in the group with recurrent cutaneous squamous cell carcinoma.

Mohs surgery is known to have lower recurrence rate compared to conventional wide excision for removal of cutaneous squamous cell carcinomas. However, cutaneous squamous cell carcinoma does sometimes recur—even after Mohs surgery. In a Korean study by Roh et al presented at the World Congress on Advanced Treatments and Technologies in Skin Cancer (Skin Cancer 2019) (Poster Board 14), researchers aimed to analyze clinical risk factors for recurrence and investigate the role of MFN-2 as a predictive biomarker for cutaneous squamous cell carcinoma recurrence.

Factors Associated With Recurrence

A total of 237 patients with cutaneous squamous cell carcinoma treated with Mohs surgery were included in the study. Among them, 36 patients showed signs of recurrence (21 patients with local recurrence and 15 patients with distant metastasis). In these patients, factors such as history of organ transplantation (P = .048), diabetes (P = .026), other malignant cancer (P = .023) and poorly differentiated histopathology of cutaneous squamous cell carcinoma (P = .024) were correlated with recurrence.

A history of trauma on the site of the cutaneous squamous cell carcinoma (P = .035) and poor differentiation (P = .019) were related with higher local recurrence. Poor differentiation (P = .001) correlated with a higher risk of distant metastasis.

Staging and Biomarkers

Among four staging systems, the AJCC 8th staging system showed the highest predictive value. Immunohistochemical staining results showed that MFN-2 expression was higher in the group with recurrent cutaneous squamous cell carcinoma compared to the group with nonrecurrent primary cutaneous squamous cell carcinoma. However, the expression level difference was not statistically significant (P = .188).

The authors wrote, “In conclusion, poor differentiation histology, solid organ transplantation recipient, comorbidity of diabetes mellitus, history of other malignancy, and trauma history on the site of cutaneous squamous cell carcinoma were high-risk factors for recurrence, [and the] AJCC 8th staging system is the most predictable system for predicting recurrence in Asian patients [with cutaneous squamous cell carcinoma] treated [with Mohs surgery]. Also, our study results suggest that MFN-2 could be a candidate for predictive biomarker for cutaneous squamous cell carcinoma; however, further studies are needed for validation.”

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.


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