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TOPLINE:

Radiologic imaging identified unexpected findings in nearly half of high-risk cutaneous squamous cell carcinoma (cSCC) cases, which led to changes in clinical management for 47%, in a retrospective cohort study.

METHODOLOGY:

• Researchers conducted a retrospective analysis of 394 tumors from 260 patients with invasive cSCC at the Cleveland Clinic between 1997 and 2022.
• A total of 138 (35%) tumors received radiologic imaging associated with primary management.
• Imaged tumors demonstrated higher-risk characteristics than nonimaged tumors, including Brigham and Women’s Hospital T stage T2b/T3 classification, location on the head and neck or trunk, moderate or poor differentiation, larger diameter, depth beyond fat, and perineural involvement (P < .001 for all).
• CT (59%), PET/CT (42%), and MRI (37%) were the most common imaging techniques. The most common reasons for imaging were treatment planning (51%) and staging (44%).
• Researchers analyzed imaging results and their impact on clinical management.

TAKEAWAY:

• Imaging identified unexpected findings in 49% of imaged tumors, most commonly local invasion beyond clinical expectations (23%) and nodal metastasis (18%).
• Imaging influenced clinical management in 47% of imaged cases, mainly changing the surgical approach (28%). Among cases with unexpected imaging findings, management was modified in 92%.
• Patients whose tumors were imaged had significantly higher rates of nodal recurrence, distant metastasis, and death from tumor (P < .001 for all).
• The 5-year disease-related outcome event rate was 36% for imaged tumors and 25% for nonimaged tumors (P = .06).

IN PRACTICE:

“In high-risk cSCC tumors, radiologic imaging reveals unexpected findings in nearly half of cases and significantly changes management,” authors of the study wrote. “These findings reinforce the need for consistent imaging, particularly of the local site and nodal basins, in the evaluation of all high-risk cSCCs to aid accurate staging and treatment planning,” they added.

SOURCE:

The study was led by Angela H. Wei, MD, Department of Dermatology, Cleveland Clinic, Cleveland. It was published online on April 17 in the Journal of the American Academy of Dermatology.

LIMITATIONS:

The single-institution retrospective design was a limitation. The selection of tumors for imaging was not standardized, and advancements in imaging technology over the study period could have influenced results.

DISCLOSURES:

The authors reported no funding sources or conflicts of interest relevant to this work.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.