{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,18]],"date-time":"2026-06-18T20:58:18Z","timestamp":1781816298344,"version":"3.54.5"},"reference-count":23,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T00:00:00Z","timestamp":1761350400000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["J Deutsche Derma Gesell"],"published-print":{"date-parts":[[2026,3]]},"abstract":"Summary<\/jats:title>\n \n Background<\/jats:title>\n In cutaneous squamous cell carcinoma (cSCC), there is a paucity of data regarding local recurrence (LR) and regional lymph node metastasis (LM) as precursors to tumor death.<\/jats:p>\n <\/jats:sec>\n \n Patients and Methods<\/jats:title>\n We estimated parameters of a multistate model with a proportion of patients without risk of progression using maximum likelihood. For seven risk factors, the relative risks of progression to LR, LM, and LR&LM were compared with the relative risks of cSCC death among patients with progression.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n Of the 1,400 patients, 124 (8.9%) were diagnosed with either LR (68), LM (42), or LR&LM (14). cSCC\u2010specific death occurred in 33 patients (2.4%), 10 by LR, 14 by LM, and 9 by LR&LM, among these 10 distant metastases. Conversely, 493 patients (35.2%) died from other causes. The risk of death from cSCC was 14.7% for LR, 33.3% for LM, and 64.3% for LR&LM. The median time to disease\u2010related death was 1.3\u00a0years.<\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n The risk of progression is limited to approximately 25% of patients. LM has been found to be associated with a higher risk of disease\u2010specific death in comparison to LR. The median interval from progression to disease\u2010specific death was found to be 1.3\u00a0years.<\/jats:p>\n <\/jats:sec>","DOI":"10.1111\/ddg.15902","type":"journal-article","created":{"date-parts":[[2025,10,25]],"date-time":"2025-10-25T10:19:12Z","timestamp":1761387552000},"page":"319-325","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Local recurrence and locoregional metastases as precursors of death by cutaneous squamous cell carcinoma"],"prefix":"10.1111","volume":"24","author":[{"given":"Helmut","family":"Breuninger","sequence":"first","affiliation":[{"name":"Department of Dermatology University Hospital T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas Kurt","family":"Eigentler","sequence":"additional","affiliation":[{"name":"Department of Dermatology Venereology and Allergology Charit\u00e9 \u2013 Universit\u00e4tsmedizin Berlin Berlin Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rolf","family":"Ulrich","sequence":"additional","affiliation":[{"name":"Department of Psychology University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Klaus","family":"Dietz","sequence":"additional","affiliation":[{"name":"Department of Medical Biometry (Emeritus) University of T\u00fcbingen T\u00fcbingen Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2025,10,25]]},"reference":[{"key":"e_1_2_8_2_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaad.2021.03.109"},{"key":"e_1_2_8_3_1","volume-title":"ICD\u201010, International Statistical Classification of Diseases and Related Health Problems: Tabular List","author":"WHO","year":"2024"},{"key":"e_1_2_8_4_1","volume-title":"AJCC Cancer Staging Manual","author":"Amin 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