Deep Dive Into High-Risk Cutaneous Squamous Cell Carcinoma

Sherrif Ibrahim, MD, PhD, provides key pearls from his co-directed session at the 2022 Annual ASDS Meeting, “Defining ‘High-Risk’ for Squamous Cell Carcinoma: Implications for Treatment Paradigms.”

During a multidisciplinary session, Sherrif Ibrahim, MD, PhD, founder of Rochester Dermatologic Surgery and an associate professor of dermatology at the University of Rochester Medical Center in Rochester, New York, participated in in-depth conversations and a panel discussion examining various challenging cases of squamous cell carcinoma. A few of the topics covered include frequency and intensity of clinical follow-up, imaging and other nodal surveillance, radiation, and systemic therapy.

Video transcript:

Hello, I'm Dr. Sherrif Ibrahim. I'm a dermatologist and Mohs surgeon in Rochester, New York. I split my time between the University of Rochester and my private practice called Rochester Dermatologic Surgery. I had the privilege of co-directing the session at this year's ASDS annual meeting in Denver, entitled, “Defining “High-Risk” for Squamous Cell Carcinoma: Implications for Treatment Paradigms.” And it was a really fantastic, thought-provoking session. We had some great speakers and then we ended the session with a panel discussion looking at various cases of challenging squamous cell carcinoma, with not such clear ways of management.

We see and treat so many squamous cell carcinomas in our practice every day, and it's hard to predict which ones do go on to have bad outcomes, and particularly have metastases to regional or distant sites. And we've made such great strides in trying to find the clinical pathologic risk factors and clinical scenarios that might clue us in to better predicting which patients do go on to have bad sequelae from their disease. Yet still there, as many as three-quarters of the patients that we say are high risk, really aren't. And as high as 1/3 of the patients who are low risk, in reality, are high risk, and do have metastatic events.

One of the things that I spoke on in particular during the session was the use of molecular prognostics. So, trying to determine individual risk assessment, based on the gene expression profiles of the tumor. While this is really a nascent field, we are making great strides in understanding how this might incorporate into our risk stratification, not just of patients globally, but for individual patients.

Incidence of squamous cell carcinoma is really high. While the rate of metastasis is low, we still see a higher death rate for squamous cell carcinomas in this country, then, compared to melanoma when we look at absolute numbers. So, this is something that I think, as we learn more, we learn how to stratify risk, how to determine individualized risk, but then ultimately, it helps us design better clinical trials so that we can potentially have some treatment interventions that could potentially slow down the number of patients that we see reduce the number of patients that go on to have metastasis. So, it was a pleasure to be part of the session. I feel like it was very fruitful, thought-provoking, and enjoyed by all attendees.

Transcript edited for clarity.

Reference:

  1. Ibrahim S. Defining ‘High-Risk’ for Squamous Cell Carcinoma: Implications for Treatment Paradigms. Presented at: 2022 American Society for Dermatologic Surgery Annual Meeting, October 7-10, Denver Colorado.