TOPLINE:

Ultrasonography and contrast-enhanced CT outperformed physical examination in detecting nodal metastases in patients with high-risk skin cancer, a study found. 

METHODOLOGY:

• A prospective diagnostic study of 13 tertiary dermato-oncology centers in Spain, conducted from January 2022 to April 2025, included 155 patients with high-risk cutaneous squamous cell carcinoma (cSCC).
• All patients (mean age, 80.3 years; 21.9% female) underwent physical examination, ultrasonography, and contrast-enhanced CT within the perioperative period (1 month before and after surgery).
• The primary outcome was sensitivity in detecting nodal metastases; secondary outcomes were specificity, positive and negative predictive values, and area under the receiver operating characteristic curve (AUC).
• Histopathologic confirmation via fine-needle aspiration or lymph node excision was performed for suspected cases, and 3-month clinical follow-up took place for negative baseline staging cases.

TAKEAWAY:

• Ultrasonography demonstrated the highest overall sensitivity at 63.6%, followed by CT at 54.5%, and physical examination at 8.3%, with specificities of 95.6%, 95.0%, and 99.3%, respectively.
• Ultrasonography and CT showed “almost perfect” agreement (Cohen kappa, 0.87) with similar overall diagnostic accuracy (AUC, 0.80 and 0.75, respectively), but poor concordance with physical examination (Cohen kappa, 0.249 and 0.132, respectively).
• Ultrasonography and CT had 100% sensitivity and excellent diagnostic accuracy in immunocompetent patients (AUC, 0.98 for both) but only 20.0% and 16.7% sensitivity, respectively, in immunosuppressed patients.

IN PRACTICE:

The study’s results “confirm the value of performing radiologic assessments of lymphatic drainage territories during baseline staging in patients with high-risk cSCC,” although “diagnostic performance dropped substantially in immunosuppressed patients,” the authors concluded. “Baseline nodal imaging with either ultrasonography or CT performs well in the detection of nodal metastasis, whereas clinical examination can fall short,” Selin Tokez, MD, PhD, and Marlies Wakkee, MD, PhD, University Medical Center Rotterdam, Rotterdam, The Netherlands, wrote in an accompanying editorial. However, they added, “For certain high-risk groups such as patients who are immunosuppressed, surveillance imaging seems to have an important additional role in maximizing diagnostic yield and facilitating early identification of occult metastases, reducing the risk of extensive treatment-related morbidity.”

SOURCE:

The study was led by Carla Ferrándiz-Pulido, MD, PhD, Department of Dermatology, Hospital Universitari Vall d’Hebron in Barcelona, Spain, and was published online on April 22 in JAMA Dermatology.

LIMITATIONS:

The main limitation of the study was the relatively low number of metastatic events. In addition, there was variability in the timing of diagnostic tests as well as intercenter and interoperator variability, and routine short-interval follow-up imaging was not included in the protocol.

DISCLOSURES:

The study authors did not report any study funding source. Ferrándiz-Pulido and two other study authors disclosed receiving personal fees, honoraria, and travel and registration fees from Almirall, Galenicum, Pierre Fabre, Regeneron, Sun Pharma, and several other drug companies outside the submitted work. Tokez and Wakkee reported having no conflicts of interest.

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