Desmoplastic Cutaneous Squamous Cell Carcinoma Is an Aggressive and Potentially Fatal Skin Cancer: A Systematic Review

The incidence and mortality of cutaneous squamous cell carcinoma (cSCC) are increasing. Desmoplastic cSCC (dcSCC) is an uncommon yet highly aggressive variant which has received relatively little attention in the literature. No systematic reviews of dcSCC are currently available. This paper aims to summarize the current understanding of the behavior of dcSCC by conducting a systematic review of published series with particular focus on outcomes. A comprehensive search was conducted for original series in English. Six studies reporting a total of 286 dcSCC were included in the final analysis. Most series were single site and retrospective. Pooled estimates demonstrated local recurrence rate 30% (95% CI: 24%-36%, p = 0.765), nodal metastasis 17% (95% CI: 12%-22%, p = 0.158), distant metastasis 5% (95% CI: 2%-9%, p = 0.574) and disease-specific death 12% (95% CI: 3%-36%, p = 0.047), outcomes which are considerably worse than non-dcSCC. The findings confirm the aggressive nature of dcSCC and suggest early aggressive treatment is warranted. However, given the limitations of existing studies, there is a need for large, prospective, multicentre studies to better define prognostic factors and optimize management strategies.