• Risk factors for recurrence of cutaneous SCC are treatment modality, size greater than 2 cm, depth greater than 4 mm, poor histological differentiation, location on the ear or mucosal areas, perineural involvement, location within scars or chronic inflammation, previously failed treatment and immunosuppression.
• The evidence base for treatment of cutaneous SCC is poor.
• None of the commonly used procedures has been tested in rigorous RCTs.
• Case series which have followed up patients with SCC treated by surgical excision, MMS, ED&C and cryotherapy all suggest 3-5-year cure rates of over 90%.
• Comparison of the cure rates between the existing main treatments is almost impossible as choice of treatment is probably based on likelihood of success (for example, only people with small uncomplicated SCCs are treated by non-surgical techniques).
• Based on the available case series, there is no evidence to suggest that any of the commonly used treatments for SCC are ineffective.
• Small (less than 2 cm tumours) at non-critical sites can probably be treated equally well by surgical excision with a 4 mm margin, ED&C or cryotherapy.
• Larger tumours, especially at sites where tissue sparing becomes vital, are probably best treated by MMS.
• RCTs are needed to inform clinicians about the relative merits of the various treatments currently used for people with SCC.
• Such trials will need to be large to exclude small but important differences, and they will need to accurately describe the sorts of people entered in terms of risk factors for recurrences. Follow up in such studies needs to be 5 years or longer.
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