Squamous Cell Carcinoma of the Skin: Surgical Therapy

Squamous cell carcinoma of the skin (cutaneous squamous cell carcinoma; CSCC) is curable (“curative”) in up to 95% by surgery.

1st order

  • Complete excision (excision in toto; surgical removal of the skin lesion in healthy tissue; R0 resection) with histologic incision margin control (per micrographic controlled surgery (MKC) with three-dimensional histologic (fine tissue) evaluation of the incision margins);
    • Sentinel lymph node biopsy (SLNB; sentinel lymph node tissue sampling): “No valid data are available on the prognostic and therapeutic value of SLNB.”
  • Superficial-horizontal shave excision with conventional histology – in the presence of superficially located squamous cell carcinoma of the skin.

Necessary safety margin to completely excise 95% of squamous cell carcinoma of the skin (PEK):

  • Low risk (“low risk”, e.g. tumor diameter ≤ 2 cm): 4 mm.
  • High risk (tumor diameter ≥ 2 cm; tumor thickness > 6 mm; poor differentiation, perineural growth, localization on ear, lip, scalp, eyelid, recurrent tumors): min. 6 mm

Notice:

  • “Until an R0 resection is histologically confirmed, wound closure should only be performed if the resection wheels can be clearly assigned postoperatively (e.g., no displacement flaps).”
  • In case of clinical suspicion of involvement of regional lymph nodes, therapeutic lymphadenectomy (lymph node removal) is recommended.
  • If complete excision is not possible or not achieved, postoperative radiotherapy (radiotherapy, radiatio) is indicated.