A multidisciplinary Delphi consensus panel (n=45) evaluated when and how to use staging and surveillance imaging for localized cutaneous squamous cell carcinoma (CSCC), across 3 iterative survey rounds (January–June 2025).
Consensus (≥80% agreement) was reached to recommend imaging for CSCCs with ≥15% metastasis risk — including tumors ≥4 cm, bone invasion, invasion beyond subcutaneous fat, or large-caliber nerve invasion. CT was the preferred modality for both nodal staging (84%) and surveillance (78%). Consensus supported imaging surveillance for at least 2 years; near-consensus (70–79%) supported at least 3 years.
Expert opinion-based Delphi design without prospective clinical validation; panel was predominantly White (67%) and academic, which may limit generalizability; thresholds (e.g., 15% metastasis risk) are consensus-derived, not empirically tested.
For CSCC with high-risk features — diameter ≥4 cm, bone or deep soft tissue invasion, large-caliber perineural invasion, or poorly differentiated histology combined with ≥2 cm size or lymphovascular invasion — obtain CT imaging for nodal staging and plan surveillance imaging for at least 2–3 years. Use this framework to standardize practice while awaiting prospective guideline data.
