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

Table 6

Management of metastatic regional nodes with curative intent.

Treatment	AAD			NCCN		ASTRO
	Narrative	LOE	SOR	Narrative	COE	Narrative	QOE	SOR
BCC	Surgery ± PORT	I, II	A	Surgery ± PORT		BCC and SCC inclusive	Moderate	Strong
	Hedgehog inhibitors			Hedgehog inhibitors		Surgery + PORT for patients with a node >3 cm, multiple nodes, and/or with ECE
	(i) vismodegib			(i) Vismodegib	2A
	(ii) Sonidegib			(ii) Sonidegib	2B
				(iii) Cemiplimab rwlc	2A
SCC	Surgery ± PORT	II	B	Surgery ± PORT	2A	Elective nodal radiation suggested in SCC with a high risk of regional metastases	Conditional	Expert opinion
				(i) ≤3 cm single node no ECE: ±PORT
				(ii) ≥2 positive node, 1 node >3 cm, no ECE: PORT yes
				Surgery + PORT ± systemic therapy	2A
				(i) Any node with ECE

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, PORT: postoperative radiation therapy, and ECE: extracapsular extension.