DANGER: what clinicians need to know about aggressive head and neck cutaneous squamous cell carcinoma

The DANGER acronym is a simple, evidence‐based aid to identify high risk squamous cell carcinoma

Non‐melanoma skin cancer (NMSC) is the most common group of malignancies diagnosed worldwide.1 Two out of three Australians will develop at least one NMSC before the age of 70 years, with about five NMSC cases diagnosed annually per one invasive cancer of another type.2 NMSC ranges from common lesions such as basal cell carcinoma and cutaneous squamous cell carcinoma (cSCC), collectively termed as keratinocyte carcinoma, to rarer lesions such as Merkel cell carcinoma, atypical fibroxanthoma, dermatofibrosarcoma protuberans, microcystic adnexal carcinoma and angiosarcoma. The most common subtype is basal cell carcinoma, comprising 70–75% of all lesions, followed by cSCC (20–25%) and Merkel cell carcinoma (< 5%).1 Exposure to ultraviolet radiation, particularly during childhood and adolescence, is the predominant aetiological risk factor for developing keratinocyte carcinomas. Therefore, a significant proportion of these malignancies develop on sun‐exposed locations, such as the head and neck, trunk and extremities.3