Consensus Panel Offers First Standardized Imaging Framework for High-Risk CSCC

A multidisciplinary panel of experts has developed consensus recommendations to help standardize staging and surveillance imaging for patients with localized cutaneous squamous cell carcinoma (cSCC), publishing the recommendations online in JAMA Dermatology.

Using a modified Delphi process, investigators recruited 45 dermatology, oncology, surgery, radiology, and otolaryngology specialists from across the United States to evaluate clinical scenarios in which imaging should—or should not—be recommended. Consensus was defined as at least 80% agreement among panelists.

The group concluded that staging and surveillance imaging should be considered for CSCCs with an estimated metastatic risk of at least 15%. Consensus or near-consensus recommendations supported imaging for tumors with suspected metastasis, bone invasion, extension beyond the subcutaneous fat, large-caliber perineural invasion, tumors measuring at least 4 cm, or combinations of poorly differentiated histology with other high-risk features, including lymphovascular invasion or tumors measuring at least 2 cm.

Among existing staging systems, respondents favored the Brigham and Women's Hospital (BWH) classification over the AJCC 8th edition when guiding imaging decisions. Imaging was consistently recommended for BWH T2b and T3 tumors, as well as AJCC T4 lesions, while low-stage tumors generally did not warrant routine imaging.

CT Preferred for Nodal Assessment

Computed tomography with intravenous contrast emerged as the preferred modality for both nodal staging (84%) and surveillance (78%). PET-CT was favored in select circumstances, including patients with underlying hematologic malignancies or those unable to receive iodinated contrast. Although ultrasonography did not achieve consensus, many panelists indicated they would incorporate it more frequently if additional expertise and training were available.

The panel also reached consensus that surveillance imaging should continue for at least 2 years after treatment, with near consensus supporting surveillance for 3 years. Most experts recommended imaging every 6 months during the first 2 years, followed by annual imaging thereafter.

The authors noted that the recommendations are based on expert consensus rather than prospective clinical trials and emphasized the need for future validation studies comparing imaging modalities and integrating individualized risk prediction tools.

"The results of this multidisciplinary Delphi panel can serve as a framework to help standardize staging and surveillance imaging for CSCC," the authors wrote. "Such guidelines may aid in generating prospective data on use in different clinical scenarios, allowing for continued refinement."

Source

Kassamali B, et al. JAMA Dermatology. Published online July 8, 2026. Doi:10.1001/jamadermatol.2026.2163.