This systematic review and meta-analysis evaluated outcomes and prognostic factors for cutaneous squamous cell carcinoma with bone invasion. The analysis demonstrated that bone invasion represents a significant adverse prognostic factor associated with higher rates of recurrence, metastasis, and disease-specific mortality. The findings support aggressive management including wide surgical excision or Mohs with bone assessment, and consideration of adjuvant therapy.

Bone invasion in cSCC is associated with significantly worse prognosis including higher recurrence and metastasis rates.

Complete bone margin assessment may require specialized techniques beyond standard Mohs frozen section processing.

Adjuvant radiation therapy should be considered for cSCC with bone invasion given the elevated recurrence risk.