The majority of SCCs are low risk and amenable to various forms of treatment, but it is essential to identify the significant proportion that are high-risk. The goal of treatment is complete (preferably histologically confirmed) removal or destruction of the primary tumour and of any metastases. In order to achieve this the margins of the tumour must be identified. SCC may give rise to local metastases, that is nodal mets, which are discontinuous with the primary tumour. Such ‘in-transit’ metastases may be removed by wide surgical excision or destroyed by irradiation of a wide field around the primary lesion. Small margins may not remove metastases in the vicinity of the primary tumour. Locally recurrent tumour may arise either due to failure to treat the primary continuous body of tumour, or from local metastases. Tumour-positive lymph nodes are usually managed by regional node dissection, or radiation for people at high risk of recurrence, and this is what NCCN recommends. Chemotherapy of any kind in the situation of nodal disease alone is investigtional.
Wagner RF, Casciato DA: Skin cancers. In: Casciato DA, Lowitz BB, eds.: Manual of Clinical Oncology. 4th ed. Philadelphia, Pa: Lippincott, Williams, and Wilkins, 2000, pp 336-373.