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Time for consensus on “high-risk” – Sentinel lymph node biopsy for cutaneous squamous cell carcinoma: an international survey of skin cancer specialists and a literature update

  • Bence C. Baljer
    Affiliations
    Department of Plastic & Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE14LP, UK
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  • Sarah R Hill
    Affiliations
    Health Economics Group, Population Health Sciences Institute, School of Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne, NE24HH, UK
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  • Diarmuid Coughlan
    Affiliations
    Health Economics Group, Population Health Sciences Institute, School of Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne, NE24HH, UK
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  • Luke Vale
    Affiliations
    Health Economics Group, Population Health Sciences Institute, School of Medicine, Faculty of Medical Sciences, Newcastle University, Newcastle-Upon-Tyne, NE24HH, UK
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  • Aidan M Rose
    Correspondence
    Corresponding author: Mr Aidan Michael Rose, Translational and Clinical Research Institute, Newcastle University, Faculty of Medical Sciences, The Medical School, Framlington Place Newcastle Univers…, Newcastle upon Tyne NE24HH, United Kingdom
    Affiliations
    Department of Plastic & Reconstructive Surgery, Royal Victoria Infirmary, Newcastle Hospitals NHS Foundation Trust, Queen Victoria Road, Newcastle upon Tyne, NE14LP, UK

    Translation and Clinical Research Institute, School of Medicine, Faculty of Medical Sciences, Framlington Place, Newcastle University, Newcastle-Upon-Tyne, NE24HH, UK
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Published:November 23, 2022DOI:https://doi.org/10.1016/j.bjps.2022.11.053

      SUMMARY

      There is an urgent need for evidence-based management of cutaneous squamous cell carcinoma (cSCC), particularly “high-risk” tumours.
      We performed an online survey of skin cancer specialists to assess cSCC research priorities. Respondents were targeted via the international Skin Cancer OUTcomes consortium (SCOUT) and the UK regional Skin Cancer Outcomes North-East (SCONE) research interest group.
      Thirty-three respondents completed the survey (46%; 16/33) were non-UK based). ‘Defining a role for sentinel lymph node biopsy (SLNB) in high-risk cSCC’ was most commonly ranked either 1st or 2nd research priority by respondents (55%; 18/33), with near-total consensus that SLNB could be useful for the early identification of nodal metastasis in high-risk cSCC (97%; 30/31).
      On this specific research priority, 24 studies with longitudinal follow-up data were identified. Cumulatively, SLNB for cSCC had positivity and false omission rates of 7.0% and 3.1%, respectively, with false negative rates of 29.0%. Given the lack of consensus on a definition of “high-risk” cSCC, it was unsurprising that only two studies of SLNB for head & neck cSCC utilised comparable selection criteria; reporting the highest positivity rates (8.0%) and lowest false-omission rates (2.4%) and false-negative rates (21.4%) overall.
      There is multi-disciplinary interest in the role of SLNB for “high-risk” cSCC. It appears to perform best in head and neck cases. A consensus definition of “high-risk” cSCC is urgently required to refine the utility of SLNB and guide risk-directed management.

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