The impact of surgical margins in managing regional metastases in cutaneous squamous cell carcinoma of the head and neck

Background: Regional metastasis occurs in 5% of cutaneous squamous cell carcinoma (cSCC). The aim of this study is to assess the impact of margin status of regional metastases on survival. Methods: A retrospective review of 401 patients with nodal metastases from cSCC. Margin status of nodal metastases was classified as clear (>1 mm), close (<1 mm), or involved. Cox regression and Kaplan–Meier methods were used to assess associations with overall and disease-specific survival (OS and DSS). Results: Of the 401 patients with nodal metastases (median age 75, 85.3% male), 43.6% had involved margins, 27.4% had close margins, and 28.9% had clear margins. Involved margins were significantly associated with reduced OS and DSS on univariable analysis. Multivariable analysis confirmed that involved margins independently predicted worse DSS (HR 1.92, 95% CI 1.15–3.19, p = 0.01). Other independent prognostic factors included size of deposit (HR 1.02, 95% CI 1.01–1.04, p < 0.001), number of deposits (HR 1.05, 95% CI 1.02–1.08, p < 0.001), and the presence of perineural invasion (HR 1.84, 95% CI 1.14–2.98, p = 0.01). Conclusions: Clear surgical margins during the removal of regional metastases of cSCC improves survival outcomes. This study highlights the importance of careful preoperative evaluation to achieve a complete (R0) surgical resection. Level of Evidence: 3 Laryngoscope, 135:2379–2384, 2025.