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23-12-2010 | Dermatology | Article

Indications for RNS, ART in HRCSCC inconsistent among surgeons


Free abstract

MedWire News: Indications for radiologic nodal staging (RNS) and adjuvant radiation therapy (ART) are not consistent among surgeons who treat high-risk cutaneous squamous cell carcinoma (HRCSCC), show US study findings.

"Decisions regarding RNS and ART are key elements in treating patients with HRCSCC, yet clinicians have little data and no clear guidelines to aid decision making… likely because of insufficient data on which to base clear recommendations," say Chrysalyne Schmults (Mohs Micrographic Surgery Center, Massachusetts, USA) and colleagues.

To further investigate the clinical management of HRCSCC among specialist physicians, Schmults and team administered a questionnaire on management of HRCSCC (n=117) or SCC with perineural invasion ([PNI], n=118) to American College of Mohs Surgery members.

The majority of surgeons cited PNI and in-transit metastasis as the main factors leading to consideration of RNS (70% and 66%, respectively), sentinel lymph node biopsy ([SLNB], 51% and 74%, respectively), or ART (85% and 65%, respectively).

The team also found that surgeons made different management decisions based on the extent of PNI. Indeed, 98% of surgeons would decline ordering ART for their patients if perineural inflammation with no nerve invasion was seen histologically. Yet, opinion was divided when dermal or subcutaneous nerves were involved.

ART was also favored for patients with more extensive nerve involvement, with 80% and 92% of surgeons considering ART in those with temporal nerve involvement and when parotidectomy was required, respectively.

Overall, 75% of surgeons did not recommend SLNB for patients with HRCSCC. Otherwise, no general consensus was observed for deciding what risk factors warranted RNS, SLNB, or ART.

Clinical experience also played a role in management decisions. Surgeons who treated more patients with HRCSCC referred significantly fewer patients for ART, as did those who treated more PNI SCCs when presented with clinical scenarios of intermediate nerve involvement.

"These results underscore the need for high-quality data on which guidelines of care can be based. Clear guidelines providing indications for RNS and ART may improve patient outcomes," conclude the authors in the Archives of Dermatology.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a trading division of Springer Healthcare Limited. © Springer Healthcare Ltd; 2010

By Ingrid Grasmo