Tumor Characteristics Predicting Perineural Invasion in Cutaneous Squamous Cell Carcinoma Identified by Stepwise Logistic Regression Analysis

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Brandon T Beal
Maulik M Dhandha
Melinda B Chu
Vamsi Varra
Eric S Armbrecht
Jordan B Slutsky
Scott W Fosko

Keywords

perineural invasion, cutaneous squamous cell carcinoma, national comprehensive cancer network, high-risk, Mohs micrographic surgery, multidisciplinary

Abstract

Background: Perineural invasion (PNInv) is a significant risk factor for metastasis and death in cutaneous squamous cell carcinoma (cSCC).  Despite this known association, factors contributing to the presence of PNInv are not well characterized.

Aims: To determine risk factors associated with the presence of PNInv using the high-risk cSCC criteria developed by the National Comprehensive Cancer Network (NCCN).

Methods: After receiving Institutional Review Board approval for this retrospective review, the presence of NCCN high-risk factors for cSCC were recorded for patients treated at a tertiary referral academic medical center, from January 1, 2010 to March 31, 2012. Stepwise logistic regression was used to identify factors associated with the presence of PNInv.

Results: PNInv was present in 34 of 507 cSCCs (6.7%). Moderately or poorly differentiated histology (P < .001, OR 6.6 [95% CI, 3.2-13.7]), acantholytic, adenosquamous, or desmoplastic subtype (P =.01, OR 1.8 [95% CI, 0.8-4.2]), and tumors in areas M (≥10mm) and H ( ≥6mm) (P = .05, OR 5.0 [95% CI, 1.2-21.0]) were significantly associated with the presence of PNInv.

Conclusions:  This data suggests clinicians should have a higher suspicion and may be able to identify PNInv in high-risk cSCC based on the presence of specific high-risk factors.

References

1. Rowe DE, Carroll RJ, Day CL Jr. Prognostic factors for local recurrence, metastasis, and survival rates in squamous cell carcinoma of the skin, ear, and lip. J Am Acad Dermatol 1992;26(6):976-90.

2. Carter JB, Johnson M, Chua TL, Karia PS, Schmults CD. Outcomes of primary cutaneous squamous cell carcinoma with perineural invasion: an 11-year cohort study. JAMA Dermatol 2013;149(1):35-41.

3. Brougham ND, Dennett ER, Cameron R, Tan ST. The incidence of metastasis from cutaneous squamous cell carcinoma and the impact of its risk factors. J Surg Oncol 2012;106(7):811-5.

4. “NCCN Guidelines version 1.2016 Squamous Cell Skin Cancers.” National Comprehensive Cancer Network. http://www.nccn.org/professionals/physician_gls/pdf/ squamous.pdf Accessed April 1, 2016.

5. Schmults CD, Karia PS, Carter JB, Han J, Qureshi AA. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol 2013;149(5):541-7.

6. Campoli M, Brodland DG, Zitelli J. A prospective evaluation of the clinical, histologic, and therapeutic variables associated with incidental perineural invasion in cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2014 Apr;70(4):630-6.