European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 1. epidemiology, diagnostics and prevention

Ketty Peris, Maria Concetta Fargnoli, Iris Zalaudek, Alexander J. Stratigos, Claus Garbe, Clio Dessinioti, Celeste Lebbe, Veronique Bataille, Lars Bastholt, Brigitte Dreno, Ana Maria Forsea, Cecille Frenard, Catherine Α. Harwood, Axel Hauschild, Christoph Hoeller, Lidija Kandolf-Sekulovic, R. Kaufmann, Nicole Wj. Kelleners-Smeets, Josep Malvehy, Veronique Del MarmolMark R. Middleton, David Moreno-Ramirez, Giovanni Pellecani, Philippe Saiag, Marieke H.J. Van Den Beuken-Van Everdingen, Ricardo Vieira, Alexander M.M. Eggermont, Jean-Jacques Grob

Research output: Contribution to journalArticle

20 Citations (Scopus)


Invasive cutaneous squamous cell carcinoma (cSCC) is one of the most common cancers in the white populations, accounting for 20% of all cutaneous malignancies. Factors implicated in cSCC etiopathogenesis include ultraviolet radiation exposure and chronic photoaging, age, male sex, immunosuppression, smoking and genetic factors. A collaboration of multidisciplinary experts from the European Dermatology Forum (EDF), the European Association of Dermato-Oncology (EADO) and the European Organisation of Research and Treatment of Cancer (EORTC) was formed to update recommendations on cSCC classification, diagnosis, risk stratification, staging and prevention, based on current literature, staging systems and expert consensus. Common cSCCs are typically indolent tumors, and most have a good prognosis with 5-year cure rates of greater than 90%, and a low rate of metastases (<4%). Further risk stratification into low-risk or high-risk common primary cSCC is recommended based on proposed high-risk factors. Advanced cSCC is classified as locally advanced (lacSCC), and metastatic (mcSCC) including locoregional metastatic or distant metastatic cSCC. Current systems used for staging include the American Joint Committee on Cancer (AJCC) 8th edition, the Union for International Cancer Control (UICC) 8th edition, and Brigham and Women's Hospital (BWH) system. Physical examination for all cSCCs should include total body skin examination and clinical palpation of lymph nodes, especially of the draining basins. Radiologic imaging such as ultrasound of the regional lymph nodes, magnetic resonance imaging (MRI), computed tomography (CT), positron emission tomography–computed tomography (PET-CT) scans are recommended for staging of high-risk cSCC. Sentinel lymph node biopsy is currently not recommended. Nicotinamide, oral retinoids, and topical 5-FU have been used for the chemoprevention of subsequent cSCCs in high-risk patients but are not routinely recommended. Education about sun protection measures including reducing sun exposure, use of protective clothing, regular use of sunscreens and avoidance of artificial tanning, is recommended.
Original languageEnglish
Pages (from-to)60-82
Number of pages23
JournalEuropean Journal of Cancer
Publication statusPublished - 2020


  • Carcinoma, Squamous Cell
  • Consensus
  • Dermatology
  • Diagnosis
  • High-risk common primary cSCC
  • Humans
  • Imaging
  • Invasive cutaneous squamous cell carcinoma
  • Locally advanced Cscc
  • Low-risk
  • Lymph Nodes
  • Magnetic Resonance Imaging
  • Medical Oncology
  • Metastatic cSCC
  • Neoplasm Staging
  • Patient Education as Topic
  • Positron Emission Tomography Computed Tomography
  • Prevention
  • Prognosis
  • Protective Clothing
  • Risk Assessment
  • Skin
  • Skin Neoplasms
  • Societies, Medical
  • Staging
  • Sunlight
  • Sunscreening Agents
  • Ultrasonography

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