Enhanced metastatic risk stratification for Cutaneous Squamous Cell Carcinoma by combining clinical guidelines with the Erasmus MC model: Results from Two Nationwide Nested Case-Control Studies

O F. Steijlen, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, Department of Dermatology - Dr. Molewaterplein 40, 3015 GD, PO Box 2040, 3000 CA Rotterdam.
L Pozza, SkylineDx B.V., Rotterdam, the Netherlands.
J J. Traets, SkylineDx B.V., Rotterdam, the Netherlands.
B Rentroia-Pacheco, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, Department of Dermatology - Dr. Molewaterplein 40, 3015 GD, PO Box 2040, 3000 CA Rotterdam.
C J. Eggermont, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, Department of Dermatology - Dr. Molewaterplein 40, 3015 GD, PO Box 2040, 3000 CA Rotterdam.
D Bellomo, SkylineDx B.V., Rotterdam, the Netherlands.
S Alex, SkylineDx B.V., Rotterdam, the Netherlands.
V A. Patel, Department of Dermatology, George Washington University School of Medicine and Health Sciences, Washington, DC, USA.
A L. Mooyaart, Department of Pathology, Erasmus University Medical Center, Rotterdam, the Netherlands.
L M. Hollestein, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, Department of Dermatology - Dr. Molewaterplein 40, 3015 GD, PO Box 2040, 3000 CA Rotterdam; Department of Research & Development, Netherlands Comprehensive Cancer Organization (IKNL), Utrecht, The Netherlands - Godebaldkwartier 419, 3511 DT Utrecht, PO Box 19079, 3501 DB Utrecht.
M Wakkee, Erasmus MC Cancer Institute, University Medical Center Rotterdam, The Netherlands, Department of Dermatology - Dr. Molewaterplein 40, 3015 GD, PO Box 2040, 3000 CA Rotterdam. Electronic address: m.wakkee@erasmusmc.nl.

Document Type

Journal Article

Publication Date

5-16-2025

Journal

Journal of the American Academy of Dermatology

DOI

10.1016/j.jaad.2025.05.1390

Keywords

cutaneous squamous cell carcinoma; guidelines; metastases; prognosis; risk prediction model; risk stratification; skin cancer

Abstract

BACKGROUND: Reliably assessing metastatic risk in cutaneous squamous cell carcinoma (CSCC) remains clinically challenging despite established guidelines. OBJECTIVE: To assess whether a clinicopathological risk prediction model (Erasmus MC model) can enhance the identification of high-risk metastatic patients within current European and National Comprehensive Cancer Network (NCCN) guidelines for CSCC. METHODS: A Dutch nested case-control (NCC) cohort (n=390 derived from N=12,325), was first stratified by guideline-defined risk groups. Each high-risk group was further stratified using thresholds for the risk estimated by the Erasmus MC model. The performance was assessed in an independent English NCC cohort (n=696, derived from N=31,981). RESULTS: The European guideline-defined high-risk group had a 3-year metastatic risk of 3.8% (95% CI 2.4%-5.2%). Within this group, 18.2% of the patients were identified with a higher 3-year risk of 10.1% (95% CI 6.7%-13.5%). For the NCCN-defined very high-risk group, the overall 3-year risk was 7.4% (95% CI 2.0%-9.2%). Of these, 34.5% of the patients had an even greater risk, of 14.0% (95% CI 8.3%-19.6%) LIMITATIONS: Routinely collected healthcare data often lacks detailed clinical information. CONCLUSION: The Erasmus MC model improves metastatic risk stratification by identifying higher risk groups within the frameworks of current European and NCCN CSCC guidelines.

Department

Dermatology

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