Update on Management Recommendations for Advanced Cutaneous Squamous Cell Carcinoma
by
,
Jesús García-Foncillas
1,2,*, 
Antonio Tejera-Vaquerizo
3,4,
Onofre Sanmartín
5,
Federico Rojo
1,
Javier Mestre
6,
Salvador Martín
7,
Ignacio Azinovic
1 and
Ricard Mesía
8 1
Departamento de Oncología, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
2
Department of Medicine, Faculty of Medicine, Universidad Autónoma de Madrid, 28040 Madrid, Spain
3
Instituto Dermatológico GlobalDerm, Palma del Río, 14700 Cordoba, Spain
4
Unidad de Oncología Cutánea, Hospital San Juan de Dios, 14012 Cordoba, Spain
5
Instituto Valenciano de Oncología, 46009 Valencia, Spain
6
Hospital Universitario Miguel Servet, 50009 Zaragoza, Spain
7
Clínica Universitaria de Navarra, 28027 Madrid, Spain
8
B-ARGO Group, Medical Oncology Department, Institut Català d’Oncologia (ICO), Badalona, 08908 Barcelona, Spain
*
Author to whom correspondence should be addressed.
Cancers 2022, 14(3), 629; https://doi.org/10.3390/cancers14030629
Submission received: 2 December 2021
/
Revised: 14 January 2022
/
Accepted: 21 January 2022
/
Published: 27 January 2022
(This article belongs to the Special Issue Prevention, Diagnosis and Treatment of Skin Cancer)
Simple Summary
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, which predominantly occurs on the head and neck. Early detection and treatment of primary tumours is crucial to limit progression and local invasion of deep tissues. While high-risk markers of poor prognosis have been identified, factors predicting regional control or survival remain uncertain. Therefore, diagnosis and management of cSCC should be performed individually, considering patient’s clinicopathological profile and the best available treatment options. Surgical excision, radiotherapy, and/or systemic treatments can be selected depending on patient’s status and tumour stage. Considering that a more comprehensive assessment will be provided by a multidisciplinary team, we aimed to generate a practical document that may assist oncologists and dermatologists on the prognosis, diagnosis, management, and follow-up of patients with advanced cSCC.
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, the incidence of which has risen over the last years. Although cSCC rarely metastasizes, early detection and treatment of primary tumours are critical to limit progression and local invasion. Several prognostic factors related to patients’ clinicopathologic profile and tumour features have been identified as high-risk markers and included in the stratification scales, but their association with regional control or survival is uncertain. Therefore, decision-making on the diagnosis and management of cSCC should be made based on each individual patient’s characteristics. Recent advances in non-invasive imaging techniques and molecular testing have enhanced clinical diagnostic accuracy. Surgical excision is the mainstay of local treatment, whereas radiotherapy (RT) is recommended for patients with inoperable disease or in specific circumstances. Novel systemic treatments including immunotherapies and targeted therapies have changed the therapeutic landscape for cSCC. The anti-PD-1 agent cemiplimab is currently the only FDA/EMA-approved first-line therapy for patients with locally advanced or metastatic cSCC who are not candidates for curative surgery or RT. Given the likelihood of recurrence and the increased risk of developing multiple cSCC, close follow-up should be performed during the first years of treatment and continued long-term surveillance is warranted.
