Craniofacial Resection for Advanced Cutaneous Squamous Cell Carcinoma: Results From the 2nd International Collaborative Case-Series

Background: Robust outcome data for anterior skull base cutaneous squamous cell carcinoma (cSCC) are limited, particularly as emerging therapies reshape management. We evaluated survival and prognostic factors following craniofacial resection. Methods: Retrospective multi-institutional case-series (1995-2015) of patients who underwent skull base surgery for anterior face/scalp cSCC. Kaplan-Meier and Cox regression analyses assessed disease-free (DFS), disease-specific (DSS), and overall survival (OS). Results: Among 112 patients, most had T4 (86.6%) and recurrent (71.4%) disease. Clear margins were achieved in 32.1%; 40.2% were involved. Five-year DFS, DSS, and OS were 46.9%, 68.4%, and 52.3%, respectively. Intracranial extension independently predicted worse OS (HR:6.54 [95% CI:2.61,16.38]) and DSS (HR:12.39 [95% CI:2.72,56.45]). Involved margins predicted recurrence on univariable analysis. Adjuvant therapy, predominantly post-operative radiotherapy, improved OS (HR: 0.54 [95% CI: 0.30,0.97]). Complications occurred in 38.4%, with 4.5% perioperative mortality. Conclusion: Advanced anterior skull base cSCC carries substantial morbidity and modest survival. These data provide a benchmark against which immunotherapy-based strategies should be evaluated.