The prognosis of local recurrence, metastases and survival in SCC depends on the location of disease and modality of treatment. The term "recurrence rate" at a post-treatment time point is preferable to "cure". The latter term wrongly suggests that no further recurrences occur after that point whereas in fact recurrence rate increases as the length of follow up increases. The overall local recurrence rate after excision of an SCC involving the sun-exposed areas is 8%, while the recurrence rates on the ear and lip are 19% and 11%, respectively.26 The metastatic rate for primary SCC of the sun-exposed areas is 5%, while the rates for SCC on the external ear, lip and non-sun-exposed areas are 9%, 14% and 38%, respectively.27 The 5-year overall survival rate associated with metastatic SCC of the skin has been estimated at 34%.27
Clinical factors that have been associated with an increased risk of local recurrence or metastases include treatment modality, size greater than 2 cm, depth greater than 4 mm, poor histological differentiation, location on the ear or non-sun-exposed areas, perineural involvement, location within scars or chronic inflammation, previously failed treatment and immunosuppression.27
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