Coudray, Nicolas and Juarez, Michelle C. and Criscito, Maressa C. and Claudio Quiros, Adalberto and Wilken, Reason and Jackson Cullison, Stephanie R. and Stevenson, Mary L. and Doudican, Nicole A. and Yuan, Ke and Aquino, Jamie D. and Klufas, Daniel M. and North, Jeffrey P. and Yu, Siegrid S. and Murad, Fadi and Ruiz, Emily and Schmults, Chrysalyne D. and Cardona Machado, Cristian D. and Cañueto, Javier and Choudhary, Anirudh and Hughes, Alysia N. and Stockard, Alyssa and Leibovit-Reiben, Zachary and Mangold, Aaron R. and Tsirigos, Aristotelis and Carucci, John A. (2025) Self supervised artificial intelligence predicts poor outcome from primary cutaneous squamous cell carcinoma at diagnosis. npj Digital Medicine, 8 (1): 105. ISSN 2398-6352

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Abstract

Primary cutaneous squamous cell carcinoma (cSCC) is responsible for ~10,000 deaths annually in the United States. Stratification of risk of poor outcome at initial biopsy would significantly impact clinical decision-making during the initial post operative period where intervention has been shown to be most effective. Using whole-slide images (WSI) from 163 patients from 3 institutions, we developed a self supervised deep-learning model to predict poor outcomes in cSCC patients from histopathological features at initial diagnosis, and validated it using WSI from 563 patients, collected from two other academic institutions. For disease-free survival prediction, the model attained a concordance index of 0.73 in the development cohort and 0.84 in the Mayo cohort. The model’s interpretability revealed that features like poor differentiation and deep invasion were strongly associated with poor prognosis. Furthermore, the model is effective in stratifying risk among BWH T2a and AJCC T2, known for outcome heterogeneity.

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