Understanding and Use of the American Joint Committee on Cancer Seventh Edition Guidelines for Cutaneous Squamous Cell Carcinoma: A Survey of Dermatologic Surgeons

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The seventh edition of the American Joint Committee on Cancer (AJCC) Cancer Staging Manual was published in 2009, including an updated chapter on cutaneous squamous cell carcinoma (cSCC) and other cutaneous carcinomas. Notable improvements from the previous sixth edition include placement of Merkel cell carcinoma and cSCC of the eyelid in individual chapters, elimination of the 5-cm clinical breakpoint for T3, and addition of high-risk features for upstaging T1 to T2 independent of clinical tumor size. Despite these advances, several publications critical of the AJCC guidelines have surfaced in the literature since their release.


To further evaluate the use and applicability of the most-recent AJCC guidelines for cSCC.


A web-based survey of members of the American College of Mohs Surgery to gauge knowledge and application of the guidelines.


Although physician knowledge of the details of the guidelines was in line with expectations, some areas for improvement (e.g., coexistent immunosuppression incorrectly listed as a high-risk feature) remain. Also, the lack of change in practice, among Mohs surgeons or dermatopathologists, as a result of the guidelines is somewhat troubling and may be an area for further research.

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