Several risk factors have been identified that are associated with poor outcomes in primary cutaneous squamous cell carcinoma, according to a systematic review and meta-analysis published online Dec. 28 in JAMA Dermatology .

George A. Zakhem, M.D., M.B.A., from NYU Langone Health in New York City, and colleagues examined all evidence-based reports of patient risk factors and tumor characteristics associated with poor outcomes in primary cutaneous squamous cell carcinoma. The meta-analysis included data from 129 studies with 137,449 patients with primary cutaneous squamous cell carcinoma and 126,553 tumors.

The researchers identified several patient risk factors and tumor characteristics that were associated with local recurrence, nodal metastasis, distant metastasis, disease-specific death, and all-cause death. Among the factors reported by more than one study, the risks for local recurrence and disease-specific death were highest in association with tumor invasion beyond subcutaneous fat (risk ratios, 9.1 and 10.4, respectively), while the risk for any metastasis was highest in association with perineural invasion (risk ratio, 5.0). The lowest incidence of nearly all poor outcomes was seen for patients who received Mohs micrographic surgery.

"These tumor characteristics should be considered in future staging systems, workup protocols, and treatment algorithms," the authors write.

Several authors disclosed financial ties to the pharmaceutical and other life science industries.

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