Similar to HPV+ oropharyngeal squamous cell carcinoma (SCC), cutaneous SCC is not well-stratified by the presence of nodal extracapsular extension alone. The problem is cSCC still uses old school staging where nodal ECE is a key component. A large Australian retrospective analysis of 1151 receiving definitive surgery +/- radiation for cSCC with pathologic nodal involvement demonstrated 82%(!) of all patients had some degree of ECE and 50% of all patients ended up being labeled with stage IV pN3b disease because of it. And while ECE is a meaningful risk factor, it’s far from the whole story: immunosuppression, perineural invasion, and size and number of nodal metastases were also important. In fact, if ECE was the only risk factor, disease-specific survival at 5 years was 88%, while it drops to 8% if ECE was present among large volume nodal disease. | Ebrahimi, JAMA Otolaryngol Head Neck Surg 2024
