Rethinking squamous cell carcinoma: which are high risk, which could benefit from lymph node dissection, what's coming up in the future?

Cutaneous squamous cell carcinomas (SCCs) are common skin cancers capable of metastasis. Determining which invasive SCCs are likely to recur or metastasize will help shape recommendations for clinical management. New prospective studies help predict which patients are at the highest risk for occult metastases and may benefit from lymph node dissection. In particular, the role of tumor depth, desmoplasia, and degree of immunosuppression could be accounted for in a more specific classification system. Evidence from studies of mucosal SCCs suggests a role for sentinel lymph node biopsies for carcinomas of the head and neck in place of selective neck dissection, a finding that may be relevant to cutaneous head and neck cancers as well. In the field of SCC pathogenesis, the role of human papillomavirus (HPV) in cutaneous, as well as mucous membrane, SCCs is being further characterized. For high-risk patients with iatrogenic immunosuppression, intense surveillance and early intervention is needed.