Coordinating Multidisciplinary Referrals in Advanced cSCC

This video series has been produced independently by Dermatology Times and supported through an educational grant by Sun Pharmaceuticals.

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? He notes that the panel's instinct toward neoadjuvant treatment implies involving oncology far earlier than dermatologists have historically done, when the reflex was often to reach for the knife or call a surgical colleague before any broader discussion.

Dr. Chandra argues that while truly multidisciplinary care is the ideal, the onus falls on whoever sees the patient first to gather the troops. Even a quick phone call or message to discuss a case can move things forward in a timely way, and she stresses that no one should operate in a silo when multiple treatment modalities have proven effective. Dr. Carr agrees, adding that complicated cases simply need the right expertise in the room, the perspective of medical oncology differs from that of head and neck surgery and radiation oncology, and these patients present many gray zones without clear-cut answers.

Dr. Patel draws the threads together, suggesting that the dermatologist is often best suited to serve as quarterback or care coordinator, given a long-standing relationship with the patient and a deep understanding of squamous cell carcinoma. He underscores a theme the panel returns to repeatedly: choosing systemic therapy does not take surgery off the table. This is an "and" situation, not an "or." Bringing the team together early, whether up front or as decisions unfold, ensures that every specialist's expertise shapes the plan without anyone washing their hands of the patient.

In the next episode, "Understanding PD-1 and PD-L1 Inhibition in cSCC," Dr. Chandra walks through the systemic therapy toolkit, from chemotherapy and EGFR inhibitors to PD-1 and PD-L1 checkpoint inhibitors, including a newer agent many clinicians haven't yet encountered.