European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention – Update 2026
Abstract
Invasive cutaneous squamous cell carcinoma (CSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS)-Dermatology Venereology, and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update guideline recommendations on CSCC (previous version 2023), based on current literature and expert consensus. Part 1 of the guidelines addresses diagnostics and prevention in immunocompetent as well as immunosuppressed patients. CSCC may be classified as easy-to-treat (vast majority) or difficult-to-treat, common primary CSCC, and is further defined as low risk or higher risk depending on the risk of recurrence or metastasis. A new classification of five groups of difficult-to-treat CSCC (DTT-CSCC) is proposed, published in 2025 by EADO experts and reflecting the commonly encountered clinical challenges. Difficult-to-treat (DTT) CSCC includes DTT-common CSCC groups 1 and 2 (which correspond to a subgroup of common CSCC that are complex to treat due to tumor and/or patient characteristics or multiplicity), DTT-CSCC group 3 corresponding to locally advanced CSCC, and DTT-CSCC groups 4 and 5 corresponding to CSCC with locoregional or distant metastases, respectively. The first step of diagnostics is based on clinical and dermatoscopic features, and is always confirmed by histopathology. The presence of risk factors characterizes higher risk CSCC, and the more risk factors, the higher the risk. After the histological diagnosis of CSCC has been established, the second step includes staging procedures, such as physical examination and, when indicated, imaging. In the third and final step, the clinical, histologic and radiologic findings are incorporated into staging systems. The more widely used staging systems are the American Joint Committee on Cancer 8th edition (AJCC8) and the Brigham and Women's Hospital (BWH) systems. Prevention strategies include oral nicotinamide and sun protection measures.
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BibTeX
@article{stratigos2026european,
title = {{European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention – Update 2026}},
author = {Alexander J. Stratigos and Clio Dessinioti and Claus Garbe and Celeste Lebbe and Teresa Amaral and Veronique Bataille and Brigitte Dreno and Reinhard Dummer and Maria Concetta Fargnoli and Ana Maria Forsea and Christoffer Gebhardt and Catherine A. Harwood and Axel Hauschild and Christoph Hoeller and Lidija Kandolf-Sekulovic and Roland Kaufmann and Nicole Wj Kelleners-Smeets and Peter Koelblinger and Aimilios Lallas and Ulrike Leiter and Konstantinos Liopyris and Veronique del Marmol and David Moreno-Ramirez and Giovanni Pellacani and Ketty Peris and Philippe Saiag and Luca Tagliaferri and Myrto Trakatelli and Ricardo Vieira and Iris Zalaudek and Petr Arenberger and Alexander C.J. van Akkooi and Alexander M.M. Eggermont and Paul Lorigan and Mario Mandala and Josep Malvehy},
journal = {European Journal of Cancer},
year = {2026},
month = nov,
doi = {10.1016/j.ejca.2026.116763},
url = {https://hal.science/hal-05850312v1},
note = {CC BY-NC},
}
RIS
TY - JOUR
TI - European consensus-based interdisciplinary guideline for invasive cutaneous squamous cell carcinoma. Part 1: Diagnostics and prevention – Update 2026
AU - Alexander J. Stratigos
AU - Clio Dessinioti
AU - Claus Garbe
AU - Celeste Lebbe
AU - Teresa Amaral
AU - Veronique Bataille
AU - Brigitte Dreno
AU - Reinhard Dummer
AU - Maria Concetta Fargnoli
AU - Ana Maria Forsea
AU - Christoffer Gebhardt
AU - Catherine A. Harwood
AU - Axel Hauschild
AU - Christoph Hoeller
AU - Lidija Kandolf-Sekulovic
AU - Roland Kaufmann
AU - Nicole Wj Kelleners-Smeets
AU - Peter Koelblinger
AU - Aimilios Lallas
AU - Ulrike Leiter
AU - Konstantinos Liopyris
AU - Veronique del Marmol
AU - David Moreno-Ramirez
AU - Giovanni Pellacani
AU - Ketty Peris
AU - Philippe Saiag
AU - Luca Tagliaferri
AU - Myrto Trakatelli
AU - Ricardo Vieira
AU - Iris Zalaudek
AU - Petr Arenberger
AU - Alexander C.J. van Akkooi
AU - Alexander M.M. Eggermont
AU - Paul Lorigan
AU - Mario Mandala
AU - Josep Malvehy
PY - 2026
DA - 2026/11/03
JO - European Journal of Cancer
DO - 10.1016/j.ejca.2026.116763
UR - https://hal.science/hal-05850312v1
AB - Invasive cutaneous squamous cell carcinoma (CSCC) is one of the most common cancers in white populations, accounting for 20% of all cutaneous malignancies. A collaboration of multidisciplinary experts from the European Association of Dermato-Oncology (EADO), the European Dermatology Forum (EDF), the European Society for Radiotherapy and Oncology (ESTRO), the European Union of Medical Specialists (UEMS)-Dermatology Venereology, and the European Organization of Research and Treatment of Cancer (EORTC), was formed to update guideline recommendations on CSCC (previous version 2023), based on current literature and expert consensus. Part 1 of the guidelines addresses diagnostics and prevention in immunocompetent as well as immunosuppressed patients. CSCC may be classified as easy-to-treat (vast majority) or difficult-to-treat, common primary CSCC, and is further defined as low risk or higher risk depending on the risk of recurrence or metastasis. A new classification of five groups of difficult-to-treat CSCC (DTT-CSCC) is proposed, published in 2025 by EADO experts and reflecting the commonly encountered clinical challenges. Difficult-to-treat (DTT) CSCC includes DTT-common CSCC groups 1 and 2 (which correspond to a subgroup of common CSCC that are complex to treat due to tumor and/or patient characteristics or multiplicity), DTT-CSCC group 3 corresponding to locally advanced CSCC, and DTT-CSCC groups 4 and 5 corresponding to CSCC with locoregional or distant metastases, respectively. The first step of diagnostics is based on clinical and dermatoscopic features, and is always confirmed by histopathology. The presence of risk factors characterizes higher risk CSCC, and the more risk factors, the higher the risk. After the histological diagnosis of CSCC has been established, the second step includes staging procedures, such as physical examination and, when indicated, imaging. In the third and final step, the clinical, histologic and radiologic findings are incorporated into staging systems. The more widely used staging systems are the American Joint Committee on Cancer 8th edition (AJCC8) and the Brigham and Women's Hospital (BWH) systems. Prevention strategies include oral nicotinamide and sun protection measures.
SN - 1879-0852
ER -