Detection of Subclinical Disease with Baseline and Surveillance Imaging in High-Risk Cutaneous Squamous Cell Carcinomas

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Journal of the American Academy of Dermatology


BACKGROUND: There are limited studies on imaging for management of high-risk cutaneous squamous cell carcinoma (HRCSSC).

OBJECTIVE: To evaluate the impact of baseline (ie, at diagnosis) and surveillance (ie, subsequent time points after diagnosis) imaging on management of HRCSCCs.

METHODS: All primary CSSCs treated at Brigham and Women's Hospital Mohs Surgery Clinic and Dana-Farber Cancer Institute High-Risk Skin Cancer Clinic from January 1, 2017 through June 1, 2019, were reviewed to identify tumors that underwent baseline or surveillance imaging. Tumors that underwent imaging were reviewed to determine the impact of imaging on management and ability of imaging to identify subclinical disease.

RESULTS: Eighty-three patients underwent imaging for 87 primary HRCSCCs, of which 48 (58%) underwent surveillance imaging. A total of 146 (59%) abnormal results were obtained from 248 imaging studies. Management was altered by 42 (24%) studies. Imaging detected subclinical disease in 21% of cases studied. A majority (56%) of detections were not seen initially but rather during surveillance imaging in the 2 years after treatment.

LIMITATIONS: Single institution retrospective design.

CONCLUSIONS: Imaging identifies subclinical disease in HRCSCC. Prospective studies are needed to determine best practices for screening and surveillance in HRCSCC.

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