The Evolving Treatment Landscape for Advanced cSCC

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

Welcome back to another Dermatology Times Case-Based Peer Perspectives series. In this episode titled "The Evolving Treatment Landscape for Advanced cSCC," moderator Vishal Patel, MD discusses advanced cutaneous squamous cell carcinoma with David Carr, MD, MPH and Sunandana Chandra, MD.

Dr. Patel sets the foundation by framing the treatment of cutaneous malignancies as a three-pronged approach: surgical resection or destructive therapies for most tumors, radiation in its various forms, and systemic therapy for tumors that advance beyond what surgery and radiation can reasonably cure. He explains that systemic options, once quite limited, now separate into immune checkpoint inhibitors, targeted agents, and chemotherapy, and that the definition of when surgery or radiation is "not feasible" keeps shifting earlier in the patient's course.

Dr. Chandra takes the panel down memory lane, recalling that when she began practicing medical oncology her options were largely chemotherapy or an EGFR inhibitor, and patients typically reached her only in late stages after multiple surgeries and rounds of radiation. She marks 2018, when the first immune checkpoint inhibitor was approved, as the turning point, explaining that more effective drugs now bring patients to medical oncology far earlier, sometimes for evaluation before surgery, alongside radiation, or immediately after it.

Dr. Patel reflects that melanoma was long the cornerstone of cutaneous malignancy management, but that squamous cell carcinoma has grown steadily more important as awareness rises and case volumes climb. He and Dr. Chandra describe a productive tension: medical oncologists are entering the picture earlier, while dermatologists are learning to think about these therapies more holistically across the whole patient rather than reaching first for the knife. Together they establish the central theme the series builds on, that advances in systemic immunotherapy have reshaped not only which drugs are available, but when and how the multidisciplinary team engages with advanced cutaneous squamous cell carcinoma.

In the next episode, "Shifting the Dermatology Mindset: Multidisciplinary Care in cSCC," Dr. Carr and Dr. Patel examine the mindset shift facing dermatologists, why earlier oncology involvement demands new communication patterns, and how established clinicians can keep pace with a rapidly changing field.