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

Table 4

Management of primary tumor with curative intent: radiation therapy.

Treatment	AAD			NCCN		ASTRO
	Narrative	LOE	SOR	Narrative	COE	Narrative	QOE	SOR
Radiation therapy
Definitive	Indicated if surgery not feasible, contraindicated, or not preferred by the patient	II, III	B	Recommended for nonsurgical candidates	2A	Indicated if the patient cannot undergo or declines surgery	Moderate	Strong
						If surgery will compromise cosmesis or function	Moderate	Conditional
						Genetic conditions predisposing to increased radiosensitivity	Expert opinion	Conditional
PORT
Both BCC & SCC	Consider for perineural invasion	II, III	B	Extensive perineural spread. Large or named nerve (>0.1 mm diameter)	2A	Gross perineural spread, clinically or radiologically	Moderate	Strong
cSCC	Not explicitly stated			Positive margins cannot be corrected with surgery	2A	Close or positive margin cannot be corrected with surgery	Low	Strong
				Consider in high/very high-risk NCCN features	2A	Setting of recurrent disease following prior margin negative resection	Moderate	Strong
					2A	Recommended for T3 and T4 tumors	Moderate	Strong
					2A	Desmoplastic or infiltrative tumors in the setting of chronic immunosuppression	Moderate	Strong
cBCC	Not explicitly stated			Positive margin where reexcision is not feasible		Close or positive margin where reexcision is not feasible	Low	Conditional
						Tumor recurrence after a prior margin negative resection	Low	Conditional
				Consider adjuvant radiation in patients with residual disease where surgery is not feasible		Tumor infiltrating bone or muscle	Low	Conditional

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, and PORT: postoperative radiation therapy.