Authors
Bina Kassamali, Jonathan D Schoenfeld, Rosh Sethi, Richard L Bakst, Christopher A Barker, Alok A Bhatt, Carol R Bradford, Paul M Bunch, David R Carr, John A Carucci, Sunandana Chandra, Michelle Chen, Karen L Connolly, Addison M Demer, Bently Doonan, Kevin Emerick, Ben J Friedman, Linna L Gali, Thomas J Galloway, Jessica L Geiger, Jeffrey P Guenette, Hillary R Kelly, Nikhil I Khushalani, Laurie Kohen, Shlomo Koyfman, Shweta Sharat Kumar, Kim O Learned, Justin J Leitenberger, Elizabeth J Lilley, John Nicholas Lukens, Theresa Medina, Devarati Mitra, David Ozog, Itai Pashtan, Vishal Anil Patel, Nancy Pham, Molly C Powers, Divya Srivastava, Paul L Swiecicki, Charlotte S Taylor, Matthew E Witek, Ashley Wysong, David Zander, Ann W Silk, Anokhi Jambusaria-Pahlajani, Emily S Ruiz
Published in
JAMA dermatology. Jul 08, 2026. Epub Jul 08, 2026.
Abstract
There is no consensus on staging and surveillance imaging for cutaneous squamous cell carcinoma (CSCC). Although imaging has been shown to affect management, broad recommendations from the National Comprehensive Cancer Network have led to variability in clinical practice.
To develop multidisciplinary consensus recommendations on the use of staging and surveillance imaging of localized CSCC.
A multidisciplinary expert panel across academic and clinical practice settings convened a Delphi consensus, with 3 iterative survey rounds from January to June 2025. Data were analyzed from February 2025 to January 2026. Eligibility defined by at least 1 to 2 CSCC publications during the previous 5 years, involvement in a relevant clinical trial, experience treating at least 3 patients monthly with CSCC, and/or 5 years or longer of clinical practice. Fifty-four experts were invited and 45 (83%) completed all 3 rounds and were included in the final analysis. Structured Delphi surveys evaluated clinical scenarios, imaging modalities, and surveillance strategies for CSCC. Consensus and near-consensus recommendations were generated, defined as 80% or greater and 70% to 79% agreement, respectively.
The 45 participants (21 female individuals [47%] and 24 male individuals [53%]; 14 Asian individuals [31%], 1 multiracial individual [2%], and 30 White individuals [67%]) consisted of dermatology (15 [33%]), medical oncology (7 [16%]), radiation oncology (9 [20%]), radiology (9 [20%]), surgery (3 [7%]), and otolaryngology specialists (2 [4%]). The Delphi panel recommended staging and surveillance for CSCCs with at least a 15% risk of metastasis. Consensus or near consensus was reached to recommend staging and surveillance imaging for tumors with a concern for metastasis, bone invasion, invasion beyond subcutaneous fat, large-caliber nerve invasion, or a diameter of 4 cm or larger or the combination of tumors with poorly differentiated histology and any of the following: diameter of 2 cm or larger, lymphovascular invasion and subcutaneous fat invasion, or lymphovascular invasion and small-caliber perineural invasion. Computed tomography imaging was the preferred modality for nodal staging (38 [84%]) and surveillance (35 [78%]). For surveillance duration, consensus was reached to provide imaging for at least 2 years, and near consensus was reached for at least 3 years.
This study provides an expert consensus-based framework to standardize imaging in localized CSCC that may inform future guidelines.
PMID:
42418212
Bibliographic data and abstract were imported from PubMed on 08 Jul 2026.
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