When is adjuvant radiotherapy recommended for a high risk squamous cell carcinoma of the skin (non-H&N) if the tumor is resected with widely negative margins and there is no perineural invasion?

Per NCCN, only +/close margins and +PNI are given as indications for adjuvant RT. However, are the presence of other risks factors considered to guide recommendations for adjuvant radiation (i.e. large tumor size >?cm, +LVSI, high grade, deep tumor invading into but not beyond subcutaneous fat)? Do multiple additional risk factors need to be present?

Answer from: Radiation Oncologist at Academic Institution

There is limited high quality evidence to guide management of "widely" excised cutaneous squamous cell carcinomas. There is an excellent prospective study reporting the outcomes of margin-negative excisions using techniques similar to Mohs surgery suggesting that there are several ri...

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When is adjuvant radiotherapy recommended for a high risk squamous cell carcinoma of the skin (non-H&N) if the tumor is resected with widely negative margins and there is no perineural invasion?

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