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MEDTECH Given the complexities of squamous-cell carcinoma of the skin and its recurrence rate, how might a multidisciplinary approach enhance patient outcomes?
In this comprehensive review of squamous-cell carcinoma of the skin, Dr. Ashley Wysong delves into the latest treatment strategies, the role of multidisciplinary consultation, and the importance of surveillance and secondary prevention.
Key Points:
- Multidisciplinary consultation and consideration of adjuvant therapy are crucial for patients who are not surgical candidates.
- The use of adjuvant radiation therapy in patients with cutaneous squamous-cell carcinoma is heavily debated due to limited consensus guidelines and a lack of long-term prospective data.
- For patients who have positive margins after undergoing Mohs micrographic surgery, adjuvant radiation therapy to the tumor basin is recommended.
- Cutaneous squamous-cell carcinoma recurs most commonly (70 to 80% of the time) within 2 years after the diagnosis, necessitating ongoing, close clinical surveillance.
- Immunosuppressed patients are at increased risk for metastasis, with organ-transplant recipients showing a pooled risk estimate for metastasis of 7.3% on the body and 11.0% in the head and neck areas.
Additional Points:
- Systemic therapy, alone or in combination with radiation therapy, is recommended for patients with recurrent, locally advanced disease who are not candidates for surgery.
- Immune checkpoint inhibitors have become the preferred regimen for systemic therapy alone, with overall response to targeted PD-1 inhibition ranging from 34 to 52% for unresectable stage la disease and metastatic disease.
- Clinical trials of neoadjuvant and adjuvant immunotherapy are ongoing in patients with high-risk cutaneous squamous-cell carcinoma.
Conclusion:
- The management of squamous-cell carcinoma of the skin requires a multidisciplinary approach, with a focus on adjuvant therapy, systemic therapy, and close clinical surveillance, particularly in immunosuppressed patients.
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“Cutaneous squamous-cell carcinoma recurs most commonly (70 to 80% of the time) within 2 years after the diagnosis. Therefore, ongoing, close clinical surveillance is recommended.”
Ashley Wysong, MD
Department of Dermatology
University of Nebraska Medical Center
Omaha
