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 tumour 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 tumour is not advanced and is still localized, a critical step is determining if the tumour has high-risk features suggesting it is aggressive. What’s aggressive behaviour 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) tumour or the characteristics of the person who has the tumour .
Large size: Size greater than 20 mm (2 cm or about 0.8 inch, the diameter of a pound). This designation applies to tumours 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 tumours:
Immunosuppression resulting from the immunosuppressive medications used after organ transplantation, infection with the human immunodeﬁciency virus (HIV), or certain blood cancers.
Older age with tumour(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.