Clinical outcomes in cutaneous squamous cell carcinoma of the head and neck: a retrospective analysis of risk factors, recurrence and metastasis.

Abstract

Introduction: Cutaneous squamous cell carcinoma (cSCC) is a common non-melanoma skin cancer primarily affecting the head and neck area, with possibility of local recurrence and metastasis. Surgical excision is the standard treatment. The objective of this study was to investigate the treatment outcomes of cSCC including local recurrence, late-onset metastasis and mortality as well as to identify the associated risk factors.

Material and methods: A retrospective single-center analysis was conducted involving patients with cSCC of the head and neck treated by surgical excision at Turku University Hospital between 2000 and 2021 with a minimum 2-year follow-up from primary surgery.

Results: A total of 195 patients, with a mean age of 79.1 years, were included. During follow-up, 17 (8.7%) recurrences were diagnosed, nine (4.6%) patients developed late-onset metastasis, and 100 (51.3%) patients died. The significant risk factors for recurrences included age ≥ 80 years (p = 0.006), poor tumor differentiation (p = 0.02) and tumor invasion depth (p = 0.02). Tumor depth also increased metastasis risk (p < 0.0001). Poor tumor differentiation (p = 0.004) and metastasis (p = 0.04) were associated with higher mortality. Greater histological deep margins decreased the risk of recurrence (p = 0.01) and metastasis (p = 0.02) and improved survival (p = 0.006). All-cause 3-year and 5-year mortality rates were 27.7 and 36.4%, respectively.

Conclusion: Deeper growing, poorly differentiated cSCC tumors of the head and neck carry a higher risk of recurrence and metastasis. Pursuing greater deep excision margins could reduce these risks. Given the high age and all-cause mortality rates of cSCC patients, close surveillance should be individualized.