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Research Letter
August 21, 2019

Surgery and Salvage Limited-Field Irradiation for Control of Cutaneous Squamous Cell Carcinoma With Microscopic Residual Disease

Author Affiliations
  • 1Department of Dermatology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
  • 2Department of Radiation Oncology, Cleveland Clinic, Cleveland, Ohio
  • 3Department of Otolaryngology, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts
JAMA Dermatol. Published online August 21, 2019. doi:10.1001/jamadermatol.2019.2190

Cutaneous squamous cell carcinoma (CSCC) is the second most common malignant neoplasm in the United States, with an estimated 1 million cases diagnosed annually.1 Most patients have an excellent prognosis with surgery alone, but a small subset have poor outcomes. Margin status following surgery greatly affects outcomes.2 Complete circumferential peripheral and deep margin assessment, which involves en face sectioning to allow for nearly 100% histologic margin assessment, is associated with lower recurrence rates compared with standard assessment, in which approximately 1% of the margin is evaluated (A. Waldman, MD, written communication, January 2019). National Comprehensive Cancer Network guidelines for CSCC include salvage radiation therapy as an option for positive histologic margins after surgical excision.3 However, there are limited data evaluating outcomes after salvage radiation therapy. Herein we review outcomes of patients with primary CSCCs treated with salvage limited-field irradiation for microscopic residual disease after surgery.

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