Evidence map›Paper›PMID 38961704›Full record

ArticleJournal of the European Academy of Dermatology and Venereology : JEADV2025

Operational classification of cutaneous squamous cell carcinomas based on unsupervised clustering of real cases by experts.

C Gaudy-Marqueste, J J Grob, C Garbe, P A Ascierto, S Arron, N Basset-Seguin, A S Bohne, C Lenoir, R Dummer, M C Fargnoli and 35 more

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Article in Journal of the European Academy of Dermatology and Venereology : JEADV, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 4 papers.

0numbers the graph read from it
0cells of the map it votes in
4citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

4 citing papers in PubMed.

  1. EADO classification of difficult-to-treat cutaneous squamous cell carcinoma in transplant recipients.Journal of the European Academy of Dermatology and Venereology : JEADV · 2026
    Article
  2. Review
  3. Article
  4. Bridging the gap: From clinical intuition to structured cutaneous squamous cell carcinoma classification.Journal of the European Academy of Dermatology and Venereology : JEADV · 2025
    Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

45 authors.

C Gaudy-MarquesteDermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France.
J J GrobDermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France.
C GarbeCentre for Dermatooncology, Department of Dermatology, Eberhard Karls University, Tuebingen, Germany.ORCID https://orcid.org/0000-0001-8530-780X
P A AsciertoDepartment of Skin Cancer, Cancer Immunotherapy and Development Therapeutics, Istituto Nazionale Tumori IRCCS Fondazione Pascale, Naples, Italy.
S ArronPeninsula Dermatology, Burlingame, California, USA.
N Basset-SeguinDermatology Department, Saint-Louis Hospital, Paris, France.
A S BohneDepartment of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
C LenoirDepartment of Dermatology, Hôpitaux Universitaires de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.ORCID https://orcid.org/0009-0004-5174-9932
R DummerSkin Cancer Centre at University Hospital Zurich, Zurich, Switzerland.ORCID https://orcid.org/0000-0002-2279-6906
M C FargnoliDermatology, Department of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.ORCID https://orcid.org/0000-0002-7249-2556
A GuminskiDepartment of Medical Oncology, Royan North Shore Hospital, Sydney, New South Wales, Australia.
A HauschildDepartment of Dermatology, University Hospital Schleswig-Holstein (UKSH), Campus Kiel, Kiel, Germany.
R KaufmannDepartment of Dermatology, Venereology and Allergology, Frankfurt University Hospital, Frankfurt, Germany.ORCID https://orcid.org/0000-0002-1614-694X
A LallasFirst Department of Dermatology, School of Medicine, Faculty of Health Sciences, Aristotle University, Thessaloniki, Greece.ORCID https://orcid.org/0000-0002-7193-0964
V Del MarmolDepartment of Dermatology, University Hospital Erasme, Universite'Libre de Bruxelles, Brussels, Belgium.
M MigdenDepartments of Dermatology and Head and Neck Surgery, UT MD Anderson Cancer Center, Houston, Texas, USA.
M PenicaudDepartment of Oto-Rhino-Laryngology and Head and Neck Surgery, APHM, La Conception University Hospital, Marseille, France.
A RembielakDepartment of Clinical Oncology, The Christie NHS Foundation Trust, Manchester, UK.
A Stratigos1st Department of Dermatology-Venereology, Andreas Sygros Hospital, National and Kapodistrian University of Athens, Athens, Greece.
L TagliaferriDipartimento di Diagnostica per Immagini e Radioterapia Oncologica, Fondazione Policlinico Universitario A. Gemelli-IRCCS, Rome, Italy.
I ZalaudekDermatology Clinic, Maggiore Hospital, University of Trieste, Trieste, Italy.
A AranceDepartment of Medical Oncology and IDIBAPS, Hospital Clínic, Barcelona, Spain.
D BadinandDepartment of Radiotherapy Oncology, Hospital La Timone, Marseille, France.
P BossiDepartment of Biomedical Sciences, Humanitas University, Milan, Italy.ORCID https://orcid.org/0000-0003-0135-0224
A ChallapalliDepartment of Oncology, Bristol Haematology and Oncology Centre, UHBW, Bristol, UK.ORCID https://orcid.org/0000-0002-3683-9583
M ClementiDepartment of Biotechnological and Applied Clinical Sciences, University of L'Aquila, L'Aquila, Italy.
A Di StefaniUOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
C Ferrándiz-PulidoDepartment of Dermatology, University Hospital Vall d'Hebron, Barcelona, Spain.
R GiuffridaDepartment of Clinical and Experimental Medicine, Dermatology - University of Messina, Messina, Italy.ORCID https://orcid.org/0000-0002-5492-3033
G L GravinaDepartment of Biotechnological and Applied Clinical Sciences, Radiotherapy and Radiobiology Unit, University of L'Aquila, L'Aquila, Italy.
P HaDepartment of Otolaryngology Head and Neck Surgery, University of California San Francisco, San Francisco, California, USA.
L HeinzerlingDepartment of Dermatology and Allergy, Ludwig-Maximilian University Hospital, LMU, Munich, Germany.
S MalletDermatology and Skin Cancer Department, Aix-Marseille University, APHM, Marseille, France.
A ParadisiUOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
P MohrDepartment of Dermatology, Elbe-Kliniken Buxtehude, Buxtehude, Germany.
A PiccerilloUOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.ORCID https://orcid.org/0000-0003-1734-7310
D RutkowskiDepartment of Dermatology, Manchester Foundation Trust, Manchester, UK.
P SaiagDepartment of General and Oncologic Dermatology, Ambroise Paré Hospital, APHP, & EA 4340 "Biomarkers in Cancerology and Hemato-Oncology", UVSQ, Université Paris-Saclay, Boulogne-Billancourt, France.
P SollenaUOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.
M TrakatelliSecond Department of Dermatology, Aristotle University Medical School, Papageorgiou General Hospital, Thessaloniki, Greece.ORCID https://orcid.org/0000-0002-4312-6557
P WojcieszekBrachytherapy Department, Maria Sklodowska-Curie National Research Institute of Oncology (MSCNRIO), Gliwice, Poland.
S S YomDepartment of Radiation Oncology, University of California San Francisco, San Francisco, California, USA.
E ZelinInstitute of Dermatology, Santa Maria Della Misericordia University Hospital, Udine, Italy.ORCID https://orcid.org/0000-0001-9276-3627
K PerisUOC Dermatologia, Dipartimento di Scienze Mediche e Chirurgiche Addominali ed Endocrino Metaboliche, Fondazione Policlinico Universitario A. Gemelli - IRCCS, Rome, Italy.ORCID https://orcid.org/0000-0003-1957-6600
J MalvehyDermatology Department, Hospital Clinic of Barcelona, IDIBAPS, University of Barcelona and CIBER de enfermedades Raras, ICIII, Barcelona, Spain.

Funding

Sanofi
6 · The paper itself

Abstract

backgroundThere is currently no staging system for cutaneous squamous cell carcinoma (cSCC) that is adapted to decision-making and universally used. Experts have unconscious ability to simplify the heterogeneity of clinical situations into a few relevant groups to drive their therapeutic decisions. Therefore, we have used unsupervised clustering of real cases by experts to generate an operational classification of cSCCs, an approach that was successful for basal cell carcinomas.

objectivesTo generate a consensual and operational classification of cSCCs.

methodsUnsupervised independent clustering of 248 cases of cSCCs considered difficult-to-treat. Eighteen international experts from different specialties classified these cases into what they considered homogeneous clusters useful for management, each with freedom regarding clustering criteria. Convergences and divergences between clustering were analysed using a similarity matrix, the K-mean approach and the average silhouette method. Mathematical modelling was used to look for the best consensual clustering. The operability of the derived classification was validated on 23 new practitioners.

resultsDespite the high heterogeneity of the clinical cases, a mathematical consensus was observed. It was best represented by a partition into five clusters, which appeared a posteriori to describe different clinical scenarios. Applicability of this classification was shown by a good concordance (94%) in the allocation of cases between the new practitioners and the 18 experts. An additional group of easy-to-treat cSCC was included, resulting in a six-group final classification: easy-to-treat/complex to treat due to tumour and/or patient characteristics/multiple/locally advanced/regional disease/visceral metastases.

conclusionsGiven the methodology based on the convergence of unguided intuitive clustering of cases by experts, this new classification is relevant for clinical practice. It does not compete with staging systems, but they may complement each other, whether the objective is to select the best therapeutic approach in tumour boards or to design homogeneous groups for trials.

Indexed as

Carcinoma, Squamous CellSkin NeoplasmsCluster AnalysisHumansMale

Identifiers

PMID38961704
PMCPMC11851250

What OpenQuestion holds

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LicenceCC BY-NC-ND
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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.