Assessing Recurrence Patterns of Cutaneous Squamous Cell Carcinoma (cSCC) in Post-surgical Patients in Iran: A Cross-sectional Study

Background: Cutaneous squamous cell carcinoma (cSCC) is a common invasive skin malignancy. This study assesses recurrence patterns and risk factors in post-surgical Iranian patients, aiming to enhance understanding and inform prevention, diagnosis, and treatment strategies for cSCC. Materials and Methods: A cross-sectional design was used in this study to evaluate the epidemiology of cSCC among patients operated at Shahid Faghihi Hospital in Shiraz, Iran, from 2016 to 2023. It included patients with confirmed cSCC who underwent surgical treatments, ensuring comprehensive data collection through medical records and patient contact. A total of 167 records were reviewed, with 78 patients meeting the inclusion criteria. Data analysis was performed in SPSS version 27.0, applying Chi-square and Fisher’s exact tests with statistical significance set at P<0.05. Results: A total of 78 patients with cSCC were included in this study, with a mean age of 61.3±17.03 years and 28.2% being female. Tumors were predominantly located on the face (25.6%), head (23.1%), neck (20.6%), and extremities (20.6%). Margin involvement was observed in 34.6% of cases. The average tumor depth was 4.72 mm, with a mean lesion length of 24 mm and a width of 22 mm. Recurrent disease occurred in 25.6% of patients, with a mean relapse time of 11.05 months. Metastasis was observed in 19.2% of cases, and 76.9% of patients were alive at the time of analysis. Tumor recurrence was significantly associated with margin involvement, adjuvant radiation therapy, chemotherapy, and metastasis (P<0.001 for all). Patients with recurrent cSCC had significantly higher mean tumor depth (5.75 mm vs. 4.36 mm, P<0.001) and wider surgical margins (5.90 mm vs. 4.62 mm, P=0.01) compared to those without recurrence. Conclusion: This study identified surgical margins, tumor depth, and metastasis as key recurrence predictors of cSCC, emphasizing the need for personalized treatment and further research on biological and molecular factors.