Imaging Bests Exam in Detecting Nodal Metastases in High-Risk cSCC

Key Takeaways

• Ultrasonography and computed tomography (CT) outperformed physical examination for detecting baseline nodal metastases in high-risk cutaneous squamous cell carcinoma (cSCC).
• Diagnostic sensitivity for imaging modalities was reduced in immunosuppressed patients.
• The authors said the results show the need for tailored staging strategies and closer follow-up in high-risk subgroups.

Ultrasonography and computed tomography (CT) outperformed physical examination for detecting baseline nodal metastases in high-risk cutaneous squamous cell carcinoma (cSCC).

Investigators for the prospective, multicenter diagnostic study evaluated baseline staging modalities for detecting nodal metastases in high-risk cutaneous squamous cell carcinoma (cSCC), comparing physical examination, ultrasonography, and contrast-enhanced computed tomography (CT) in 155 patients with histologically confirmed high-risk disease, defined as stage T2b/T3 or T2a with additional risk factors.

The cohort had a median age of 80.3 years, and 41.3% were immunosuppressed. Within 3 months of surgery, 7.7% of patients developed nodal metastases. Ultrasonography demonstrated the highest sensitivity (63.6%), followed by CT (54.5%) and physical examination (8.3%). Specificity remained high across modalities, exceeding 95% for all approaches. Agreement between ultrasonography and CT was strong (κ = 0.87), while concordance with physical examination was limited.

Subgroup analyses showed differences by immune status. Among immunocompetent patients, ultrasonography and CT each achieved 100% sensitivity and high diagnostic accuracy (AUROC 0.98), while sensitivity was noted to decline significantly in immunosuppressed patients, with ultrasonography and CT demonstrating sensitivities of 20.0% and 16.7%, respectively. Nodal metastases developed frequently in this subgroup, the authors noted, despite negative baseline imaging.

“These findings suggest that ultrasonography and CT can be used interchangeably for baseline nodal staging in high-risk cSCC,” the authors wrote in the abstract. “However, reduced performance in immunosuppressed patients highlights the need for tailored staging strategies and vigilant follow-up.”

Source: Ferrándiz-Pulido C, et al. JAMA Dermatology. Published online, April 22, 2026. Doi: 10.1001/jamadermatol.2026.0803