My dad had 6mm by 6mm lesion on forehead two months ago. It was diagnosed as squamous cell carcinoma (biopsy was done; pathology report said it was well differentiated, invasive, and the examined inked margins were free). We went with Moh's surgery and margins were found clear when first layer was removed and examined by Moh's surgeon. I wanted to request guidance on whether Sentinel Node Biopsy should be done in such cases (to be 100%sure). Many thanks, in advance. Please, kindly reply.
Is Sentinel Node Biopsy Needed for Squamous Cell Carcinoma?
Doctor Answers 2
Sentinel Node Biopsy for Squamous Cell Carcinoma
Whenever you consider a procedure, you think about the potential risks of the procedure (including financial costs) vs. the potential benefits. In my opinion there is minimal benefit to perform sentinel node biopsy on a small, well-differentiated, squamous cell carcinoma on the forehead treated with Mohs surgery (and with clear margins on the biopsy). Risk factors that would increase consideration of performing sentinel node biopsy would include large size, deep penetration, poorly differentiated, recurrent tumor, high-risk location (e.g. ear, lips, genitalia), etc. While there is a very small risk of metastasis with squamous cell carcinoma, the likelihood that sentinel node biopsy would provide any benefit in this case is extremely small.
Other tumors where sentinel node biopsy are sometimes used include intermediate thickness melanomas and merkel cell carcinomas. The decision to perform any procedure, including sentinel node biopsy, should ultimately be based on discussion between a patient and their physician. Good luck.
Sentinel Node Biopsy after Mohs
Unless your father has had other cancers in his body, a sentinel node biopsy wouldn't be necessary after Mohs for squamous cell carcinoma and in all honestly, probably wouldn't be covered by his insurance in this case either, and it's a very expensive procedure! From your statements the initial path report didn't show the SCC was abnormal or had any other types of cancer cells apparent. A sentinel node biopsy would only need to be done (and approved by insurance) if other cancer type cells were shown in the biopsy report.