ADVANCED CUTANEOUS SQUAMOUS-CELL CARCINOMA OF THE TRUNK AND EXTREMITY- ANALYSIS OF PROGNOSTIC FACTORS

Background: Patients with squamous cell carcinoma (SCC) of the skin ma y exhibit locally advanced or metastatic disease and present a challen ging management problem. Methods: A retrospective review of 40 patient s with advanced SCC of the trunk or extremity managed at Roswell Park Cancer Institute from 1982 through 1992 was performed to identify clin ical and pathologic factors that influenced outcome. Results: There we re 27 males and 13 females with a median age of 61 years. Median follo w-up was 24 months. Surgical resection to control the primary tumor wa s often extensive. Amputation was required in nine patients, hemipelve ctomy in three patients, and hemicorporectomy in one patient. Median s urvival was 28 months, and 5-year survival was 43%. Univariate analysi s identified stage (P = 0.04), size (P = 0.0001), type of surgical pro cedure (P = 0.009), and margins of resection (P = 0.005) as having pro gnostic significance. On multivariate analysis, stage (P 0.04) and siz e (P = 0.02) were found to be significant. Conclusions: Optimum treatm ent for advanced SCC of the trunk and extremity involves surgical rese ction with uninvolved margins. The role of elective node dissection re mains undefined. Investigation is needed to define the role of neoadju vant therapy that may improve functional and cosmetic results. (C) 199 7 Wiley-Liss, Inc.