A 45-member expert panel has released the first consensus-based imaging guidelines for cutaneous squamous cell carcinoma (CSCC), filling a long-standing clinical gap. The recommendations advise imaging for staging in any CSCC with at least a 15% metastasis risk, with CT as the preferred modality for most patients. Serial surveillance imaging is recommended for at least 2 years after diagnosis in high-risk cases.
For the first time, clinicians managing cutaneous squamous cell carcinoma (CSCC) have a structured, expert-backed framework for when and how to use imaging. A 45-member multidisciplinary panel — spanning dermatology, oncology, radiology, and surgery — used a three-round Delphi consensus process to develop recommendations published in JAMA Dermatology. The key threshold: imaging for staging is recommended for any CSCC carrying at least a 15% risk of metastasis.
The guidelines draw on two major staging systems — the Brigham and Women's Hospital (BWH) and the AJCC8 — to tailor imaging decisions to specific tumor features. Low-risk tumors (T1/T2a in BWH; T1/T2 in AJCC8) require no imaging, while higher-risk lesions with features like lymphovascular invasion, subcutaneous fat invasion, or large tumor diameter warrant both staging and surveillance imaging. CT is the preferred modality for most patients, though PET-CT is favored for extensive disease or concomitant hematologic cancers.
Key Takeaways:
Why it matters: Prior to these guidelines, imaging practices for CSCC varied widely, and major cancer networks offered only vague guidance. This framework gives clinicians a practical, evidence-informed starting point — and sets the stage for prospective studies to further refine recommendations.
