CUTANEOUS squamous cell carcinoma imaging guidance could standardize staging and surveillance for higher risk localized disease.
Cutaneous Squamous Cell Carcinoma Imaging Guidance
A multidisciplinary Delphi consensus has produced expert recommendations for staging and surveillance imaging in localized cutaneous squamous cell carcinoma, addressing a long standing gap in clinical guidance. The study was developed in response to the absence of consensus on when imaging should be used in cutaneous squamous cell carcinoma, despite evidence that imaging can affect management and broad recommendations that have contributed to variability in practice.
The expert panel included 45 participants who completed three iterative survey rounds between January and June 2025. Specialists represented dermatology, medical oncology, radiation oncology, radiology, surgery, and otolaryngology, reflecting the multidisciplinary nature of cutaneous squamous cell carcinoma care. Consensus was defined as at least 80% agreement, while near consensus was defined as 70% to 79% agreement.
Higher Risk Features Drive Imaging Recommendations
The panel recommended staging and surveillance imaging for cutaneous squamous cell carcinomas with at least a 15% risk of metastasis. Consensus or near consensus supported imaging when tumors raised concern for metastasis, bone invasion, invasion beyond subcutaneous fat, large caliber nerve invasion, or a diameter of 4 cm or larger.
Imaging was also recommended for tumors with poorly differentiated histology when accompanied by additional risk features. These included a diameter of 2 cm or larger, lymphovascular invasion with subcutaneous fat invasion, or lymphovascular invasion with small caliber perineural invasion. Together, these recommendations provide a more structured approach to identifying patients whose disease may warrant radiologic assessment.
CT Preferred For Staging And Surveillance
Computed tomography imaging emerged as the preferred modality for nodal staging, supported by 38 panelists, representing 84% agreement. It was also the preferred modality for surveillance, supported by 35 panelists, representing 78% agreement.
For surveillance duration, the panel reached consensus on imaging for at least 2 years, with near consensus supporting imaging for at least 3 years. The authors concluded that this expert consensus based framework may help standardize imaging use in localized cutaneous squamous cell carcinoma and inform future guidelines.
Reference
Kassamali B et al. Consensus Guidelines for Staging and Surveillance Imaging in Cutaneous Squamous Cell Carcinoma. JAMA Dermatol. 2026;doi:10.1001/jamadermatol.2026.2163.
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