Over 15 years, advanced cutaneous squamous cell carcinoma has moved from limited chemotherapy and EGFR inhibition to checkpoint blockade. Dr. Chandra and Dr. Patel trace how the 2018 approvals restructured treatment sequencing and the timing of oncologic involvement.
As systemic therapy enters earlier in the disease course, coordinated care becomes essential. Dr. Carr and Dr. Patel examine the communication infrastructure, such as tumor boards, referral pathways, and cross-specialty literacy, that distinguishes academic centers from community practice.
Dr. Patel presents the program's first case: a 78-year-old woman with an enlarging, ulcerated lesion on the right temple and preauricular area, measuring close to five centimeters.
Building on the first case, Dr. Patel poses a practical dilemma: when a true multidisciplinary team isn't available in real time, who should a community dermatologist reach out to first, a surgeon, a radiation oncologist, or a medical oncologist?
Dr. Chandra walks the panel through the systemic therapy toolkit for advanced squamous cell carcinoma, organizing it into three categories.
Dr. Chandra examines the safety profiles of the checkpoint inhibitors, cautioning that patient numbers remain small and cross-trial comparisons imperfect.
Dr. Patel introduces the second case: a 72-year-old man with a rapidly enlarging lesion on the left forehead, now just over three centimeters, ulcerated, and sitting above the left eyebrow.
With Mohs surgery complete, three stages to clear a defect greater than four centimeters extending to the periosteum, Dr. Patel details the pathology: a poorly differentiated tumor, 5.7 millimeters thick, with multifocal small-caliber perineural invasion above the clinically significant threshold.
Dr. Chandra details the CPOST trial, a randomized phase 3 study in which 415 patients received either adjuvant cemiplimab for one year or placebo.
