Advanced Cutaneous Squamous Cell Carcinoma Is Associated with Suboptimal Initial Management in a Cohort of 109 Patients

Dermatology. 2019;235(6):516-521. doi: 10.1159/000500636. Epub 2019 Aug 6.

Abstract

Background: Little is known about the epidemiological characteristics of patients with advanced cutaneous squamous cell carcinoma (A-cSCC).

Objective and method: A retrospective study was conducted on a routine care cohort of 109 patients to identify the epidemiological factors associated with A-cSCC.

Results: The median age was 83 years (IQR: 73.9-89.8), and the median ECOG was 1 (IQR: 1-2). Sixty percent of the patients had a history of cardiac disease and 22% had cognitive disorders. Seventy-four percent of patients were from rural/semi-rural areas (towns of <15,000 residents) and 17% were living in nursing homes. The cSCC lesions were on the head and neck in 72% of cases. Thirty-seven percent of patients were not diagnosed until the disease was in an advanced stage, indicating a lack of cSCC identification. In the remaining 69 patients, 7% did not received treatment within 3 months of the cSCC being identified, 62% had an incomplete histological report, and 37% had incomplete treatment.

Conclusion: A-cSCC is associated with incomplete initial treatment in an elderly and rural population with good general condition. We hypothesize that a lack of access to good dermatological expertise may have led to underestimation of the aggressiveness of cSCC and/or therapeutic mismanagement.

Keywords: Advanced cutaneous squamous cell carcinoma; Epidemiology; Management.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Biopsy / statistics & numerical data
  • Carcinoma, Squamous Cell / diagnosis*
  • Carcinoma, Squamous Cell / epidemiology
  • Carcinoma, Squamous Cell / pathology*
  • Carcinoma, Squamous Cell / therapy
  • Delayed Diagnosis
  • Female
  • Head and Neck Neoplasms / diagnosis*
  • Head and Neck Neoplasms / epidemiology
  • Head and Neck Neoplasms / pathology*
  • Head and Neck Neoplasms / therapy
  • Humans
  • Male
  • Neoplasm Staging
  • Palliative Care / statistics & numerical data
  • Referral and Consultation / statistics & numerical data
  • Retrospective Studies
  • Rural Population / statistics & numerical data
  • Skin / pathology
  • Skin Neoplasms / diagnosis*
  • Skin Neoplasms / epidemiology
  • Skin Neoplasms / pathology*
  • Skin Neoplasms / therapy
  • Time-to-Treatment