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.