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Soo Park, MD
Soo Park, MD
Posted: Monday, April 22, 2024
Given the lack of universally accepted staging systems, assessment of both basal cell and squamous cell cancers is a clinical challenge, noted Jeremy Bordeaux, MD, MPH, of Case Western Reserve University, Cleveland, at the 2024 NCCN Annual Conference. Chair of the NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) Panel for Basal Cell Skin Cancer, Dr. Bordeaux noted the updated NCCN Guidelines offer criteria for risk stratification of these non-melanoma skin cancers (basal cell, squamous cell). He focused his presentation on the characteristics of each risk status classification and the corresponding treatment options.
In the NCCN Guidelines, basal cell carcinomas are stratified into four categories: low risk, high risk, locally advanced disease, and initial presentation of regional or distant metastatic disease According to Dr. Bordeaux, nearly all the of cases fall into the first two categories. Key factors to consider are tumor location and size, borders, history of recurrence, immunosuppression, history of radiation therapy, histologic subtype, and the presence or absence of perineural invasion.
For low-risk basal cell skin cancer, recommended treatments include curettage/electrodesiccation, shave removal, and standard excision with 4-mm clinical margins without tissue rearrangement. “For [patients with high-risk disease], we are going to do Mohs micrographic surgery or some form or margin control,” said Dr. Bordeaux. For metastatic or nodal basal cell skin cancers, radiation therapy, systemic therapy, and enrollment on a clinical trial are options, he added, so multidisciplinary consultation is key.
As with basal cell skin cancers, the NCCN Guidelines stratify squamous cell skin cancers based on risk. The risk factors are similar to those for basal cell carcinoma, but they also include growth rate, neurologic symptoms, and risk based on pathology for squamous cell carcinoma. The recommended treatment options for low-risk squamous cell tumors are similar to those for low-risk basal cell tumors. As for high-risk squamous cell tumors, he would consider a sentinel lymph node biopsy followed by Mohs surgery or peripheral margin control or standard excision with larger margins.
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