DS15: Five-year outcomes for cutaneous squamous cell carcinoma treated by shave surgical excision with curettage and cautery

Christopher Phillips, Leenah Abuelgasim, Matthew Wedlich, Eleni Ieremia, William Perkins and Rubeta Matin

Churchill Hospital, Oxford, UK

Curettage and cautery with curative intent is recommended for clinically low-risk cutaneous squamous cell carcinoma (cSCC) in the 2020 British Association of Dermatologists (BAD) guidelines. Low risk includes well-defined, primary cSCC (< 1 cm diameter) in immunocompetent individuals. In our centre, the surgical procedure for this is shave excision followed by curettage and cautery three times (‘shave, C&C × 3’). There is limited evidence in the literature regarding outcomes for this technique. We undertook a retrospective case note review of cSCC histopathology reports from 1 January 2016 to 31 December 2016. Inclusion criteria were confirmed histopathological diagnosis of cSCCs treated with ‘shave, C&C × 3’ as the sole primary surgical treatment. Medical records were accessed to risk stratify each cSCC as low, high and very high, and to establish local recurrence rates over a 5-year period. Data were entered into and analysed using Microsoft Excel. Overall, 701 cSCCs were treated surgically in 2016; 626 of these underwent surgical excision and were therefore excluded; 67 cSCCs were treated with ‘shave, C&C × 3’, but 12/67 underwent subsequent surgical excision. In the final analysis, 55 cases of cSCC treated exclusively by ‘shave, C&C × 3’ were included, with a mean duration of follow-up of 49 months (range 2–60). The mortality rate was 35%, and no deaths were secondary to cSCC. Mean age at diagnosis was 79 years (range 57–95); 55% were male. Thirty-five (64%) cSCCs were head-and-neck sites, including nose (n = 7), cheek (n = 7), ear (n = 7), scalp (n = 6), neck (n = 3), forehead (n = 3), temple (n = 1) and medial canthus (n = 1); seven (13%) were immunosuppressed. Thirty-nine (71%) were ‘low risk’, 16 (29%) ‘high risk’ and none ‘very high risk’, as defined by the BAD guidelines. Local recurrence occurred in four cases (7%), with no metastases. One cSCC recurrence was ‘high risk’ (site of tumour was ear) and the other three were ‘low risk’. Mean time to recurrence was 12·5 months (range 3–33); three out of four recurrences occurred within 10 months. Our retrospective review supports the surgical practice of shave excision followed by curettage and cautery three times provided there are no ‘high risk’ clinicopathological features. We report a local recurrence rate of 7% of all cSCCs treated with definitive intent by ‘shave, C&C × 3’ with the risk of recurrence greatest in the first year following surgery. Clinicians should be appropriately skilled to undertake this procedure and should avoid it for clinically high-risk lesions, including high-risk body sites, immunosuppression or a tumour diameter exceeding 1 cm.