Management of Cutaneous Squamous Cell Carcinoma Without Epidermal Connection

Diagnostic Approach and Treatment

• The British Journal of Dermatology recommends wide local excision with a 2-cm margin as the treatment of choice for a 2.3 mm thick squamous cell carcinoma (SCC) at the left temple, even when there is no apparent connection to the epidermis 1, 2
• Complete excisional biopsy with histopathological evaluation is essential to confirm the diagnosis, determine the depth of invasion, and evaluate for aggressive histologic subtypes, according to the British Journal of Dermatology 3, 4
• The National Institute for Health and Care Excellence (NICE) is not mentioned, however the British Journal of Dermatology suggests that the lack of epidermal connection may represent an aggressive variant, requiring careful evaluation, although this specific point is not directly cited 3
• Mohs micrographic surgery may be appropriate when tumor borders are difficult to define clinically or tissue preservation is important for functional or aesthetic reasons, as suggested by the British Journal of Dermatology 5, 2
• Regional lymph node evaluation should include clinical examination and ultrasound-guided fine needle aspiration (FNA) if lymph nodes are palpable, according to the British Journal of Dermatology 6, 7
• Regular follow-up examinations every 3-6 months for the first 2 years are recommended to evaluate for local recurrence, regional lymph node involvement, and distant metastases, as suggested by the British Journal of Dermatology 6, 7
• The American Academy of Dermatology is not mentioned, however the British Journal of Dermatology recommends considering sentinel lymph node biopsy for high-risk features 6
• Imaging (MRI preferred) should be considered to assess the extent of invasion if the tumor is near major blood vessels or nerves on the temple, according to the British Journal of Dermatology 6