Defining patients with high-risk cutaneous squamous cell carcinoma

Non-melanoma skin cancers occur at an epidemic rate in Australia. With an ageing population more Australians will develop these cancers and at an increasing rate. In the majority of cases, local treatment, usually excision, is highly curative. However, a subset of the population are diagnosed with a high-risk cutaneous squamous cell carcinoma, defined as a patient having a higher risk of subclinical metastases to regional lymph nodes based on unfavourable primary lesion features and patient factors. Despite treatment, patients developing metastatic cutaneous squamous cell carcinoma experience mortality and morbidity usually as a consequence of uncontrolled metastatic nodal disease. It is therefore important that clinicians treating skin cancers have an understanding and awareness of these high-risk patients. The aim of this article is to discuss the features that define a high-risk patient and to present some of the issues pertinent to their treatment.