Diagnostic Modalities and Nodal Staging in High-Risk Cutaneous Squamous Cell Carcinoma

What is the diagnostic performance of physical examination, ultrasonography, and computed tomography (CT) for baseline nodal staging in high-risk cutaneous squamous cell carcinoma (cSCC), and does a patient’s immune status affect performance?This multicenter diagnostic study including 155 patients found that ultrasonography and CT outperformed physical examination and showed high concordance in detecting nodal staging in high-risk cSCC, with overall sensitivity of 63.6% for ultrasonography, 54.5% for CT, and 8.3% for physical examination. All metastatic cases were correctly detected in immunocompetent patients by CT and ultrasonography; however, sensitivity dropped sharply in immunosuppressed individuals, where most nodal metastases emerged within 3 months despite negative baseline imaging.Ultrasonography and CT may be superior to physical examination for early detection of nodal metastases in high-risk cSCC, but their limited performance in patients with immunosuppression warrants tailored guideline recommendations.

Corresponding Author: Carla Ferrándiz-Pulido, MD, PhD, Department of Dermatology, Hospital Universitari Vall d’Hebron, Paseo Vall d’Hebron 119-129, Barcelona 08035, Spain (carla.ferrandiz@vallhebron.cat).

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