DS09: Targeted follow-up for cutaneous squamous cell carcinoma

Natalie King,¹ Charlotte Gollins² and Adam Bray¹

¹University Hospitals Bristol and Weston NHS Foundation Trust and ²North Bristol NHS Trust, Bristol, UK

The incidence of cutaneous squamous cell carcinoma (cSCC) is increasing annually in England by 5% (Venables ZC, Nijsten T, Wong KF et al. Epidemiology of basal and cutaneous squamous cell carcinoma in the U.K. 2013–15: a cohort study. Br J Dermatol 2019; 181: 474–82). This and an ageing population leads to a higher number of more complex patients with advanced and recurrent cSCC. The local experience of the management of patients prior to locoregionally recurrent or metastatic cSCC was audited in 2019, and the literature on risk stratification reviewed. Subsequently, new local guidelines were implemented aiming to target hospital follow-up on those most at risk and reduce follow-up appointments overall. We risk-stratified every new primary cSCC at the multidisciplinary team meeting (MDT), broadening the category of low risk to include some solitary higher risk factors, and allocating this group to a single group education session then discharge. All high-risk cases were discussed for consideration of adjuvant and prophylactic treatments to include at least 2 years of secondary care follow-up. The 2020 British Association of Dermatologists (BAD) cSCC guidelines recommend cases with any high-risk factor receive at least 2 years of hospital follow-up. However, there remains a paucity of data on optimal follow-up schedules that make a clinical difference. This re-audit assessed local management of these patients with the new protocol, and considered their risk stratification in light of the new BAD guidelines. We evaluated patients presenting with locoregionally recurrent or metastatic cSCC across two centres by searching the cancer registry between January 2019 and July 2021. We assessed primary treatment and follow-up to determine if our new follow-up schedule had caused any recurrences to present late, adversely affecting their clinical outcome. Forty-four cases were identified. Details of the primary treatment were missing for four out-of-area patients, who were therefore excluded. Forty had full data available. Nineteen had received MDT stratification via the new protocol. These patients all received high-risk follow-up except two. These two patients had been triaged as low risk, but both developed a local cutaneous recurrence before their scheduled single follow-up (despite complete excision). Treatment of these two patients was therefore not delayed. The single high-risk factor for both patients was lesion diameter > 20 mm. Of the 21 on the old follow-up protocol, two might have also been triaged as low risk and discharged under the new protocol. One of these patients presented with recurrence more than 3 years later so a change in follow-up schedule would not have affected outcome. Sixty-one per cent of recurrences were identified by the patients themselves. No patients with recurrent or metastatic cSCC were harmed by our modified follow-up schedule over 2 years. We estimate 400 follow-up appointments per year were saved vs. the previous follow-up schedule.