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[Background]: Although the eighth edition of the American Joint Committee on Cancer staging system (AJCC8) provides improved prognosis stratification of cutaneous squamous cell carcinoma (CSCC) over AJCC7, T3 has a variable prognosis., [Objective]: To define prognostic subgroups in T3-AJCC8 CSCC., [Methods]: Retrospective cohort study of 196 primary T3-AJCC8 CSCCs. We conducted multidimensional scaling analysis using the 6 risk factors that define T3 CSCCs. The prognoses of the groups obtained were analyzed by means of competing risk analysis., [Results]: Group 1 was characterized by a tumor thickness greater than 6 mm (without invasion beyond the subcutaneous fat), alone or in combination with a tumor width of at least 4 cm. Group 2 was characterized by the presence of either invasion beyond the subcutaneous fat or by the involvement of nerves (≥0.1 mm, or deeper than the dermis). Group 3 was characterized by the combination of both T3b risk factors, or of 3 or more risk factors. Group 3 (tentatively named T3c) patients had the worst prognosis for disease-specific poor outcome events and major events, Group 2 (T3b) had intermediate risk, and Group 1 (T3a) had the best prognosis (disease-specific poor outcome events: hazard ratio [HR], 1.94; P = .00009; major events: HR, 2.55; P = .00001; disease-specific death: HR, 10.25; P = .0009)., [Limitations]: Retrospective study., [Conclusions]: There is statistically significant evidence that T3-AJCC8 may be classified into distinct prognostic subgroups., Funding sources: Dr Cañueto is partially supported by the grants PI18/000587 (Instituto de Salud Carlos III, cofinanciación Fondo Europeo de Desarrollo Regional [FEDER]) and GRS 1835/A/18 (Gerencia Regional de Salud de Castilla y León), and by the Programa de Intensificación de la Actividad Investigadora de la Gerencia Regional de Salud de Castilla y León (INT/M/10/19), Spain.

[Introduction]: The Brigham and Women's Hospital and the Tübingen cutaneous squamous cell carcinoma (SCC) stratification systems propose different criteria from the American Joint Committee on Cancer, eighth edition. Our group identified prognostic subgroups within T3 stage according to the American Joint Committee on Cancer eighth edition's classification, the most common classification for high-risk cutaneous SCCs., [Objective]: To compare the performance and prognostic accuracy of these staging systems in a subset of high-risk cutaneous SCCs., [Methods]: Homogeneity, monotonicity, and McNemar tests for pairwise comparisons were assessed. Distinctiveness and relative risk of poor outcome were calculated by stage. Prognostic accuracy was compared with respect to quality (Akaike and Bayesian information criteria), concordance (Harrell C-index and Gönen and Heller concordance probability estimate), and predictive accuracy (sensitivity, specificity, negative predictive value, positive predictive value, and global accuracy)., [Results]: The Brigham and Women's Hospital and Salamanca systems were more distinctive, homogeneous, and monotonic than the Tübingen system. The Tübingen system was the most specific, whereas the Salamanca and Brigham and Women's Hospital systems were more sensitive. Negative predictive value was high in all 3 systems, but positive predictive value and accuracy were low overall., [Conclusions]: Alternative staging systems may partially overcome the heterogeneity and low prognostic accuracy of the American Joint Committee on Cancer, eighth edition and enable high-risk cutaneous SCCs to be stratified more reliably, but their prognostic accuracy is still low. Considering the accumulation of risk factors may improve high-risk cutaneous SCC risk stratification., Dr Cañueto is partially supported by grant PI18/000587 (Instituto de Salud Carlos III, cofinanced by FEDER funds).

Background: Skin cancer is a serious health problem in our society, and UV radiation is the most significant agent in its development. Photoprotection and awareness of the risks of developing skin cancer are the basic pillars in its prevention. As future healthcare professionals, medical students’ knowledge of these questions is likely to influence the effectiveness with which they can promote appropriate behavior regarding sun exposure among their patients. Our objective was to assess the knowledge and awareness of photoprotection among medical students and their behavior regarding sun exposure.Methods: A Google questionnaire comprising 54 questions about the risks of skin cancer and photoprotective habits was developed. 228 participants were recruited to the study, of whom sixth-year and fourth-year students were the most and least strongly represented groups, respectively. Statistical analysis was performed using IBM SPSS Statistics 26.Results: Significantly more fifth- and sixth-year students had knowledge of the meaning of the sun protection factor (SPF) than those in pre-clinical years (P=0.006), and more of them were aware of the risks of developing skin cancer (P=0.039). A higher percentage of female than male students took FPS into account when buying sunscreen (P=0.023), and male students are more likely to be reluctant to apply sunscreen than female students (P=0.022). A higher proportion of women than men in the study used sunscreen for outdoor activities (P=0.015).Conclusions: Prevention of sun overexposure is a public health priority, and medical students will be in charge of informing the general population in the future. Most students who are currently studying medicine have some knowledge of skin cancer prevention, although there are significant differences between sexes and year of study. However, their behavior indicates that their knowledge does not consistently translate from theory into practice.