My 47 yr old son was diagnosed with squamous this week. Is waiting till 10/15 for rem. too long?

Question

His doctor referred him to a specialist who could not work him in for 6 weeks. It frightens me.

Answer 1

Hello,

I'm sorry about this.

I imagine your son has a 'squamous cell carcinoma' somewhere, and the most likely place seems to be  the skin?  If it's the lung, prostate or elsewhere, this answer is going to be no good.

Well, assuming now that it's in the skin, - we don't know how long he has had it so far, where it is on the body, how big it is now, and if there is any suggestion of spread already?

We also don't know whether he will be having a 'surgical biopsy' (a diagnostic removal) on October 15th, or a 'final surgical treatment' on October 15th.   I would imagine a 'first surgical removal,'  which would count as a biopsy.   ('Final surgical removal' involves the removal of local spread and of involved lymph nodes, - if any, - which you don't mention.)

I must admit that if I had a squamous cell carcinoma (SCC) of the skin, I would want it removing sooner than in 6 weeks' time.  But that is on general grounds.  

Clearly you need some recent research about "squamous cell carcinoma, - outlook for recurrence, - time to treatment-starting," i.e. is there research to show that the prognosis (outlook) is worse if surgical treatment is delayed?

I have searched the Internet but not come up with the ideal answer.  I have the advantage of being able to speak medical language, so I do understand research papers pretty well.  But it is not really in the medical profession's interest, I fear, to investigate "outlook" versus "time to treatment starting" too closely.

The best Google search seems to be <"time to surgery OR treatment" AND "skin cancer" > if you want to try it yourself.

If you look at http://www.emedicine.com/ent/topic26.htm you will find (under the heading, "Identifying High-Risk Lesions"),

- - (1) that SCC larger than 2cm across, have a 2 times higher rate of recurrence locally, and a 3 times higher rate of distant spread, than smaller ones,

- - (2) that SCC of the ear or around the ear, have a 3 times higher rate of distant spread than those sited elsewhere, - also the lip,

- - (3) that SCC going 4mm deep into the skin, have a 7 times higher rate of distant spread than those that go only 3mm deep into the skin.  This is a big hike with "depth more than 3mm," - 3mm is not that much.

i.e. a position near the ear or on the lip, a size bigger than 2cm across, and a depth of 4mm or greater, - each indicate a much worse outlook on standard treatment. This may help your case, or not.  

You could measure the cancer now, on your son, maybe.  If it is close to 2cm across or more, then he is already in a high-risk group.  The same if it is on the ear or lip.  That should brook no further delay, in my opinion.

I have located one interesting study, which  concerns a comparison of patients with skin cancer which was (a) diagnosed in a Clinic, or  (b) diagnosed with the help of a remote televison-based picture transfer.  

This is at http://www.liebertonline.com/doi/pdfplus... number 130.  

This study showed that:

- - The average time to diagnostic surgical biopsy was 57 days, (from Clinic diagnosis), and 38 days (from telemedicine diagnosis).  

- - The average time to final surgical removal, was 125 days (from Clinic) and 105 days (from telemedicine).

Unfortunately they did not go on to analyze whether the telemedicine patients did better after their treatment, because they had gotten surgical treatment that bit quicker.  

However, we *can* say from this study that:

- - (a) surgical biopsy in 8 weeks is average, and that biopsy in 5 and a half weeks is better than average, in America; and

- - (b) that final surgical treatment in 18 weeks is average, and that final surgical treatment in 15 weeks is better than average in America.

- -  How is this going to compare with your son's experience of 6 weeks, presumably to biopsy or initial surgical treatment?  It seems to lie between 'better than average' in America (5 weeks), and 'average' in America (8 weeks).

Another good study I've found is at http://www.nature.com/jid/journal/v124/n...

It compares treatment delay, with 'precisely how much skin had to be removed to get the skin cancer out completely.'

What they concluded was, (slightly simplified), -  "Delay of more than 1 year between first diagnosis of a squamous skin cancer,  and its precise surgical removal under microscope control,  was associated with surgical skin-holes that were twice as large as those where delay was shorter."

What this means is, that it takes a full 52 weeks' delay in treatment, before a worsening in the patient's outlook is detectable.  The authors also say that if they had instead, studied the outlook after only 26 weeks' delay in surgery, then no difference in outlook would have been statistically detectable.

This is, in a way, quite reassuring for you and your son. But on the other hand it is not of much use to you, in seeking to speed up the surgery.

The authors of this study also admitted that  "There has been limited investigation of the relevance of treatment delay and squamous skin cancer size."  This is pretty much what I speculated at, above.  Unfortunately.

I hope this is of some help.

Best wishes,

Belliger (retired uk gp)

Answer 2

Call your doctor back and tell him you have to wait that long. Sometimes doctors will intercede to speed things along. Ask him if you should be worried.