Background
Most cutaneous Squamous Cell Carcinoma (cSCC) are small lesions treated with simple excision but some are problematic that require significant surgery and/or radiotherapy. AJCC Staging based on clinical/radiological findings may not accurately reflect biological extent of the disease. We investigated whether pathological staging based on histological analysis provides more accurate staging.
Methods
cSCCs included in the Hutt Valley District Hospital Head and Neck database between 1997 and 2021 were analysed. Those managed in local theatres with simple excisions with/without local flaps or skin grafts were excluded.
Results
A total of 346 patient with 386 episodes met the criteria. 18 (4.7%) episodes were clinical stage I disease, 76 (19.7%) were stage 2, 181 (46.9%) were stage 3, and 111 (28.8%) were stage 4. The distribution of staging was similar once pathological staging was determined, but 18.9% were upstaged and 13.2% were down staged following the histological analysis. For T staging only, 14.7% were upstaged and 8.5% were down staged following histological analysis. For N staging, 17.1% were upstaged and 9.6% were down staged. Cohen’s kappa, used to measure the agreement between clinical and pathological staging, showed moderate level of agreement for staging group and moderate to good level of agreement for T and N staging.
Discussion
The differences in the clinical and pathological staging group is unlikely to be significant given the moderate to good level of agreement observed in both T and N staging.
Conclusion
Histological analysis provides similar staging to clinical/radiological staging.