Craniofacial Resection for Advanced Cutaneous Squamous Cell Carcinoma: Results From the 2nd International Collaborative Case-Series.

Abstract

Robust outcome data for anterior skull base cutaneous squamous cell carcinoma (cSCC) are limited, particularly as emerging therapies reshape management. We evaluated survival and prognostic factors following craniofacial resection. Retrospective multi-institutional case-series (1995-2015) of patients who underwent skull base surgery for anterior face/scalp cSCC. Kaplan-Meier and Cox regression analyses assessed disease-free (DFS), disease-specific (DSS), and overall survival (OS). Among 112 patients, most had T4 (86.6%) and recurrent (71.4%) disease. Clear margins were achieved in 32.1%; 40.2% were involved. Five-year DFS, DSS, and OS were 46.9%, 68.4%, and 52.3%, respectively. Intracranial extension independently predicted worse OS (HR:6.54 [95% CI:2.61,16.38]) and DSS (HR:12.39 [95% CI:2.72,56.45]). Involved margins predicted recurrence on univariable analysis. Adjuvant therapy, predominantly post-operative radiotherapy, improved OS (HR: 0.54 [95% CI: 0.30,0.97]). Complications occurred in 38.4%, with 4.5% perioperative mortality. Advanced anterior skull base cSCC carries substantial morbidity and modest survival. These data provide a benchmark against which immunotherapy-based strategies should be evaluated.