The study by Jambusaria-Pahlajani et al is a reminder that management of high-risk nonmelanoma skin cancers, particularly cutaneous squamous cell carcinoma, is an ad hoc process unsupported by systematic data. Even among Mohs surgeons, who collectively treat a large fraction of the high-risk cutaneous squamous cell carcinomas diagnosed in the United States, there is wide variation of management practices. After local excision is performed, opinions diverge regarding the need for further tests and treatments. The practice gap is that consensus is lacking regarding the need for sentinel lymph node biopsy or adjuvant radiotherapy in patients with so-called high-risk cutaneous squamous cell carcinoma.
Alam M. Uncertainty and Variance in the Management of High-Risk Cutaneous Squamous Cell CarcinomaComment on “Uncertainty in the Perioperative Management of High-Risk Cutaneous Squamous Cell Carcinoma Among Mohs Surgeons”. Arch Dermatol. 2010;146(11):1231-1232. doi:10.1001/archdermatol.2010.1231