Certain high-risk features are markers of an aggressive squamous cell skin cancer. These features are related to the location, size, and pathologic features of the tumor as well as certain characteristics of the patient.
When the specialist examines your pathology specimen from the biopsy, s/he will evaluate if your cancer is advanced or not. If the tumor is not advanced and is still localized, a critical step is determining if the tumor has high-risk features suggesting it is aggressive. What’s aggressive behavior for a squamous cell skin cancer? We can think of an aggressive skin cancer (like other cancers) as one that spreads to distant body sites. But squamous cell skin cancers can also act aggressively when they spread locally and invade other tissues such as your nerves, bone, and other structures. An estimated five percent of squamous cell skin cancers are aggressive, meaning they are at increased risk for causing a lot of damage when they grow deep below your skin, coming back to the same location, or spreading to other parts of your body.
Below are the features that make squamous cell skin cancer high risk. These can be related to the primary (original) tumor or the characteristics of the person who has the tumor.
Large size: Size greater than 20 mm (2 cm or about 0.8 inch, the diameter of a nickel). This designation applies to tumors on the trunk and extremities
Specific Invasive Features:
Certain symptoms: Causing pain and itchiness (which may indicate neurologic involvement)
Certain tumor subtypes: acantholytic, desmoplastic, and metaplastic
Presence of multiple tumors
Less Differentiation: This detail about your tumor is something reported on your pathology report—it means the tumor is acting “younger” and less like a mature squamous cell. This designation means it has greater potential to cause trouble.
A history of prior tumors coming back
Immunosuppression resulting from the immunosuppressive regimens used after organ transplantation, infection with the human immunodeficiency virus (HIV), or certain blood cancers
Older age with tumor(s) on the head and neck
A history of very intense/prolonged sun exposure
The greater number of high-risk features, the more likely the squamous cell skin cancer will have a poor outcome. To see how risk features are integrated into the staging of squamous cell skin cancer, see STAGING SQUAMOUS CELL SKIN CANCER: A PRACTICAL DESCRIPTION.