Comparative Analysis of US Guidelines for the Management of Cutaneous Squamous Cell and Basal Cell Carcinoma

Table 3

Management of primary tumor with curative intent: surgical management.

Treatment	AAD			NCCN		ASTRO
	Narrative	LOE	SOR	Narrative	COE	Narrative	QOE	SOR
Standard excision						Details of surgical management outside the scope of ASTRO guidelines
SCC
Low risk	4–6 mm margin to depth of subcutaneous adipose tissue	II	B	4–6 mm margin and postoperative margin assessment	2A
High risk	Select tumors	II	B	Select tumors. Wider surgical margin and postoperative margin assessment	2A
Very-high risk	Not defined	II	B	Select tumors. Wider surgical margin and postoperative margin assessment	2A
BCC
Low risk	4 mm margin	I	A	4 mm margin and postoperative margin assessment	2A
High risk	Select tumors	II, III	C	Select tumors. Wider surgical margin with postoperative margin assessment	2A
Mohs/PDEMA
SCC	High-risk tumors	II, III	B	High/very high-risk tumors	2A
BCC	High-risk tumor	I, II	A	High-risk tumors	2A
C & E
SCC	Low-risk tumors. Exclude lesions of terminal hair-bearing areas	II, III	B	Low-risk tumors. Exclude terminal hair-bearing skin lesions	2A
BCC	Low-risk tumors. Exclude tumors of terminal hair-bearing areas	I, II	B	Low-risk tumors. Exclude terminal hair-bearing skin lesions	2A

AAD: American Academy of Dermatology (Reference #[9, 11]), NCCN: National Comprehensive Cancer Network (Reference #[13]), ASTRO: American Society of Radiation Oncology (Reference #[12]), LOE: level of evidence, QOE: quality of evidence, SOR: strength of recommendation, COE: category of evidence, C & E: curettage and electrodessication,and PDEMA: peripheral and deep enface margin assessment.