Comparison of treatment modalities for squamous cell carcinoma

Dermatologic surgeons have numerous treatment modalities in their armamentarium for nonmelanoma skin cancer and specifically squamous cell carcinoma (SCC). These include such destructive modalities as curettage and electrodesiccation (C&E), cryotherapy, and carbon dioxide laser ablation. Excision and curettage prior to excision offer extremely effective modalities for complete extirpation of cutaneous SCC and would be the standard of care that other modalities need to be compared with. Mohs micrographic surgery offers the highest cure rates possible for selected high-risk squamous cell carcinomata. Radiation therapy can yield high cure rates with reasonable morbidity using modern techniques. Large, well-controlled prospective studies to determine cure rates and recurrence rates for these various modalities do not exist except for Mohs micrographic surgery.(1) This is particularly true for less orthodox treatment modalities, such as intralesional or topical 5-fluorouracil, shave excision, and photodynamic therapy. Cutaneous SCC is an increasingly common problem. The incidence and morbidity is increasing although this trend is relatively poorly documented.(2) Efforts to better document the natural history of cutaneous carcinoma, its morbidity and mortality, cure rates, and recurrence rates and develop detailed registries and clinical databases are underway.(3) The available literature already suggests that treatment decisions should be based on numerous clinical and histologic parameters as described below.(1,4,5) An effort by our dermatopathologists to incorporate this clinical and histologic data into pathology reports and thus into pathology data bases may help us better understand this increasingly common disease.(6)