∙ Rachel Manci, MD ∙ Samantha S. Sattler, MD ∙ Daniel Lozeau, MD ∙ Jordan B. Slutsky, MD
Introduction
Cutaneous squamous cell carcinoma (cSCC) is the second most common cutaneous malignancy, and its incidence continues to increase over time. While cSCC generally portends a favorable prognosis, significant morbidity and mortality are possible in its more advanced stages.1 The high-risk prognostic factors currently described by the American Joint Committee on Cancer (AJCC) eighth edition and the Brigham and Women’s Hospital (BWH) include tumor diameter greater than 2-cm, depth of invasion beyond the subcutaneous fat, bony invasion, poor-differentiation, and perineural invasion.2 Intravascular invasion of cSCC is a rare histopathologic finding that is not currently described in either cSCC staging guideline, yet may influence locoregional recurrence and patient prognosis.3-5 Herein, we present 2 cases of cSCC with intravascular invasion identified during Mohs micrographic surgery (MMS), summarize the prognostic data that are available to date, and provide management recommendations for surgical cases exhibiting this high-risk feature.
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