The median time to local recurrence was 11.3 months (range 1-112 months, 95% confidence interval [CI], 8.8-14.6)
Clinical Pearls
The median time to local recurrence was 11.3 months (range 1-112 months, 95% confidence interval [CI], 8.8-14.6)
In terms of surveillance, 74.3%, 84.9%, and 95.5% of local recurrence were detected within 2, 3, and 5 years, respectively
The median time to distant metastasis was 11.9 months (range 1.2-42.6 months, 95% CI, 8.6-13.7)
Discussion:
Cutaneous squamous cell carcinoma is highly prevalent in the United States, with approximately 1 million cases diagnosed annually. Recurrence rates have been measured in the literature for this disease and range from 2.7% to 7.5%. Few studies have investigated recurrence rates and survival stratified by stage of the tumor. This study intends to analyze the timing and type of recurrences, and disease specific mortality in a dual-institutional cohort, with the end goal of providing data for risk-appropriate clinical surveillance.
Primary cSCCs that underwent curative intended treatment were identified from two major medical centers: Brigham and Women’s and Cleveland Clinic Foundation, from 2010 to 2019 and 2010 to 2012 respectively. All cancers that developed a recurrence (local, regional, distant), intransit metastasis, and those that caused a disease specific death were included. Initially metastatic tumors, mucosal tumors, in-situ cancers, and metastatic SCC of unknown origin were excluded.
In total 321 tumors were analyzed from 296 patients in this cohort. The median time to local recurrence was 11.3 months (range 1-112 months, 95% confidence interval [CI], 8.8-14.6). In terms of surveillance, 74.3%, 84.9%, and 95.5% of local recurrence were detected within 2, 3, and 5 years, respectively. When analyzing regional metastasis, the median time until recurrence (in-transit metastasis and nodal metastasis) was 9.7 months (range 1-68.3 months, 95% CI, 8.8-11.7) with 86.8%, 94.5%, and 99.4% detected within 2, 3, and 5 years, respectively. The median time to distant metastasis was 11.9 months (range 1.2-42.6 months, 95% CI, 8.6-13.7). The time to recurrence was similar for all outcomes when stratified by Brigham and Women’s Hospital tumor stage.
Overall, the results of this study indicate that the average time to cSCC recurrence or death occurs in the first year of diagnosis with more than 95% of poor outcomes occurring by 3 years. It is important to note that, time to recurrence or disease specific death did not change with tumor stage. This study is valuable in assisting clinicians to develop optimal follow up regarding cSCC, with the conclusion that the highest yield period for detecting cSCC recurrence being the first 3 years after diagnosis.
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