van Helmond S C, Cozzi S, Breugelmans B, Codazzi D, Valdatta L, Carminati M
Plastic and Reconstructive Surgery Unit, ASST Papa Giovanni XXIII, Bergamo, Italy.
Faculty of Health, Medicine and Life Sciences, Maastricht University, Maastricht, the Netherlands.
JPRAS Open. 2025 Mar 6;44:316-330. doi: 10.1016/j.jpra.2025.02.007. eCollection 2025 Jun.
Cutaneous squamous cell carcinoma, which makes up for 25% of keratinocyte carcinomas, is the second most frequent skin cancer worldwide. Surgical excision via a clinical and microscopic complete resection is the treatment of choice. Incomplete excisions carry the risk of local recurrence, deep subclinical progression, and metastasis. This retrospective cohort study aimed to investigate the risk factors associated with the incomplete excision of cutaneous squamous cell carcinoma. This series included 837 patients who underwent surgical treatment for 1082 primary cutaneous squamous cell carcinoma in the Plastic Surgery Department of the Papa Giovanni XXIII Hospital in Bergamo, Northern Italy between 2012 and 2021. Patient-, procedure-, and tumor characteristics were collected and analyzed. Incomplete excision rate was 11.8% (n=128). The Pearson chi-squared test and univariable logistic regression showed tumor diameter [cm] (p<0.001), tumor thickness [mm] (p<0.001), tumor location (ear p=0.006, peri-orbital, p=0.029), differentiation grade (G3=0.005), infiltration level (hypodermis, p<0.001; muscle, p=0.013; bone/ cartilage p<0.001), presence of perineural invasion (p=0.041), ulceration (p=0.010), no prior diagnostic biopsy (p=0.041), and additional samples taken (p<0.001) with additional samples not free of tumor cells (p<0.001) to be significant risk factors/ predictors for incomplete excision. Risk factors should be considered in the management of cutaneous squamous cell carcinoma. This study documented several key contributions and confirmations regarding the risk factors associated with incomplete excision in cutaneous squamous cell carcinoma by comprehensively analyzing of one of the largest cohort studies in the field.
皮肤鳞状细胞癌占角质形成细胞癌的25%，是全球第二常见的皮肤癌。通过临床和显微镜下完全切除进行手术切除是首选治疗方法。切除不完全有局部复发、深部亚临床进展和转移的风险。这项回顾性队列研究旨在调查与皮肤鳞状细胞癌切除不完全相关的危险因素。该系列研究纳入了2012年至2021年期间在意大利北部贝加莫的帕帕·乔瓦尼二十三世医院整形外科接受手术治疗的837例患者，他们共患有1082例原发性皮肤鳞状细胞癌。收集并分析了患者、手术和肿瘤特征。切除不完全率为11.8%（n = 128）。Pearson卡方检验和单变量逻辑回归显示，肿瘤直径[cm]（p < 0.001）、肿瘤厚度[mm]（p < 0.001）、肿瘤位置（耳部p = 0.006，眶周p = 0.029）、分化程度（G3 = 0.005）、浸润水平（皮下组织，p < 0.001；肌肉，p = 0.013；骨/软骨p < 0.001）、神经周围浸润情况（p = 0.041）、溃疡（p = 0.010）、未进行过诊断性活检（p = 0.041）以及额外取样情况（p < 0.001）和额外取样中存在肿瘤细胞（p < 0.001）是切除不完全的重要危险因素/预测因素。在皮肤鳞状细胞癌的管理中应考虑这些危险因素。本研究通过全面分析该领域最大的队列研究之一，记录了关于皮肤鳞状细胞癌切除不完全相关危险因素的几个关键贡献和确认信息。
