Recommendations for the management of cutaneous squamous cell carcinoma: a systematic multidisciplinary Delphi consensus approach

There are gaps and unanswered questions in clinical guidelines regarding several aspects of the management of patients with cutaneous squamous cell carcinoma (cSCC).

A scientific committee of ten cSCC specialists in Spain (dermatology, medical oncology, oral and maxillofacial surgery, plastic surgery, and radiotherapy) used ADAPTE methodology to develop recommendations by: (i) identifying clinical questions not fully answered by clinical practice guidelines; (ii) systematically reviewing the literature (published between November 2017 and July 2023 in PubMed and the Cochrane database) and grading the evidence (using Oxford levels); (iii) developing recommendations and assessing those with no consensus among the scientific committee or with evidence level 3–5 or strength of recommendation under C or D in a two-round Delphi method; and (iv) developing the final recommendations in the form of answers to key clinical questions, grading the strength of recommendation. An external group of 32 experts plus the members of the committee participated in both Delphi rounds, evaluating the appropriateness and need of the recommendations.

Initially, 33 recommendations were made for 26 questions; 19 recommendations were evaluated with the Delphi method. All 19 recommendations were deemed appropriate and necessary. A total of 27 final recommendations were made, concerning initial patient management, treatment of the primary tumour, management of advanced disease, specific populations, supportive and palliative care, and follow-up.

We developed 27 recommendations that answer clinical questions on the management of patients with cSCC, providing guidance on aspects that are unclear in clinical guidelines or on which guidelines differ.