Staging Systems and Risk Stratification in cSCC

In “Staging Systems and Risk Stratification in cSCC,” our panel explores the challenges and complexities of accurately categorizing patients with cutaneous squamous cell carcinoma (cSCC) into appropriate risk groups to guide prognostication and treatment planning. The expert faculty discuss commonly used staging systems, including the Brigham and Women’s Hospital (BWH) and AJCC criteria, and highlight how factors such as tumor size, differentiation, depth of invasion, and perineural invasion contribute to current risk stratification approaches.

The panel also examines the limitations of traditional staging systems in identifying patients at highest risk for recurrence and metastasis. Through real-world patient examples, the expert faculty discuss how some patients classified as low risk may ultimately experience aggressive disease behavior, while others with high-stage tumors may undergo intensive treatment without poor outcomes. The discussion highlights the ongoing challenge of balancing undertreatment and overtreatment in cSCC management, particularly when determining the need for adjuvant therapies.

Additionally, the panel reviews emerging evidence suggesting that additional clinicopathologic and molecular features beyond traditional staging criteria may improve prognostication and patient selection. The expert faculty also discuss the variability and subjectivity associated with dermatopathological assessment, particularly regarding moderately differentiated tumors, and how evolving diagnostic tools may support more precise and personalized management strategies in cSCC.

Our next episode, “Delayed Diagnosis and Early Detection in cSCC,” features the panelists discussing the evolving role of molecular profiling and gene expression profiling in improving risk stratification and identifying patients with cSCC who may require closer surveillance or more aggressive management strategies.