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SIGN 140 Management of primary cutaneous squamous cell carcinoma

Skin cancers are a major and increasing health burden in our ageing population. Cutaneous squamous cell carcinoma (SCC) has increased in incidence by more than 50% in the 10-year period from 2001 to 2011. Whilst many SCC are low-grade and readily treated with surgical excision, there remains an important minority that grow rapidly, are highly invasive and carry a risk of metastasis and death.

The overall rate of metastasis is low (<5%) but, where distant metastases are present, the five-year survival is poor at only 25-40%. Treatment options are limited once distant metastasis or unresectable locoregional recurrence has developed, so it is important that patients with high-risk SCC are discussed at the skin cancer multidisciplinary (MDT) meeting to ensure adequate initial treatment.

This guideline provides recommendations for referral, management and follow up of patients aged 18 years and over with primary invasive SCC. It addresses pathological, clinical and tumour features, or combination of features, that best facilitate risk stratification in patients with primary invasive cutaneous SCC.

The recommendations aim to help healthcare professionals to: