Cumulative incidence and disease-specific survival of metastatic cutaneous squamous cell carcinoma: A nationwide cancer registry study

Selin Tokez, Marlies Wakkee, Wilner Kan, Zoe C. Venables, Antien L. Mooyaart, Marieke Louwman, Tamar Nijsten, Loes M. Hollestein*

*Corresponding author for this work

    Research output: Contribution to journalArticlepeer-review

    27 Citations (Scopus)


    Background: Cutaneous squamous cell carcinoma (cSCC) represents the most serious form of keratinocyte cancers because of its metastatic potential. Studies on nationwide incidence and disease-specific survival rates of metastatic cSCC (mcSCC) are lacking. Objective: To investigate the cumulative incidence and disease-specific survival of patients with mcSCC in the Dutch population and assess patient-based risk factors. Methods: We conducted a nationwide cancer registry study including all patients with the first cSCC in 2007 or 2008, using data from the Netherlands Cancer Registry, the nationwide network and registry of histopathology and cytopathology, and Statistics Netherlands. Cumulative incidence and Kaplan-Meier curves were calculated, and time-dependent Cox proportional hazards regression analyses were used. Results: Of the 11,137 patients, metastases developed in 1.9% (n = 217). The median time to metastasis was 1.5 years (interquartile range 0.6-3.8 years). The risk factors were age (adjusted hazard ratio [aHR] 1.03, 95% CI 1.02-1.05), male sex (aHR 1.7, 95% CI 1.3-2.3), and immunosuppression (aHR [organ transplant recipient] 5.0, 95% CI 2.5-10.0; aHR [hematologic malignancy] 2.7, 95% CI 1.6-4.6). The 5-year disease-specific survival for patients with mcSCC was 79.1%. Limitations: Only histopathologically confirmed mcSCCs were included. Conclusion: About 2% of cSCCs metastasize, with higher risk for men, increasing age, and immunocompromised patients. Disease-specific survival for patients with mcSCC is high.

    Original languageEnglish
    Pages (from-to)331-338
    Number of pages8
    JournalJournal of the American Academy of Dermatology
    Issue number2
    Publication statusPublished - Feb 2022

    Bibliographical note

    Publisher Copyright:
    © 2021 American Academy of Dermatology, Inc.


    • cancer registry
    • cutaneous squamous cell carcinoma
    • epidemiology
    • hematologic malignancy
    • incidence
    • keratinocyte carcinoma
    • metastasis
    • organ transplantation
    • survival


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