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Case Study
Could this patient benefit from lower intensity treatment?
An elderly Caucasian male, over 90 years old, presents with two NCCN high risk factors.
Case details
The patient's lesion was a 3.1cm x 2.9cm primary cutaneous squamous cell carcinoma (cSCC) on the left lateral neck. The patient required multiple stages of Mohs surgery and no additional high-risk pathological features were observed. The final post-surgical defect size was 4.4 x 4.1 cm.
- SLNB
- Radiation
- Follow-up every 6 months
Why DecisionDx-SCC?
Due to the patient’s age, and the extensive Mohs surgery, the clinician preferred to avoid radiation and sentinel lymph node biopsy (SLNB). However, the clinician was concerned with the patient having two NCCN high risk factors, and the DecisionDx-SCC GEP test was ordered to help inform the level of post-surgical care required.
Test result
In this patient, the DecisionDx-SCC test result of Class 2A indicates a higher biological risk for metastasis (18.8%). This assisted the clinician in deciding to forgo reflexive SLNB and radiation and to proceed with a lower intensity-level of treatment follow-up every three months. Three months post-treatment the wound healed and there was no sign of the disease present.
In light of the Class 2A DecisionDx-SCC test result, the indication of a higher risk of metastasis, and the patient’s age, the clinician determined that a lower intensity level of post-surgical management with more frequent surveillance would be more appropriate for the patient. A reflexive SLNB and radiation treatment was deemed unnecessary and removed from the patient’s care plan. Follow-up was scheduled for monthly wound check, and nodal exams were scheduled for every 3 months, rather than 6 months. Three months post-treatment, the wound had healed with no evidence of recurrence or metastasis.
DecisionDx-SCC testing provided valuable objective information and helped determine a lower intensity level of post-surgical management with more frequent surveillance would be more appropriate.
