Non-Surgical Management for High-Risk Cutaneous Squamous Cell Carcinoma

The presentation discusses non-surgical management options for high-risk cutaneous squamous cell carcinoma (SCC), focusing on neoadjuvant, adjuvant, and systemic therapies. The speaker, after stating his disclosures, emphasizes the inadequacy of historical surgical paradigms and surgical clearance data for advanced SCC. Results from various studies reveal that adjuvant therapies such as radiation can be ineffective, highlighting the importance of shifting towards neoadjuvant treatments. Two notable studies present promising outcomes with neoadjuvant immunotherapy, evidencing high pathologic response rates, resulting in improved disease-free survival rates. The NCCN guidelines have now included neoadjuvant immunotherapy as a recognized treatment option, fostering a shift in practice patterns at cancer centers. Challenges in clinical practice are examined, such as deciding surgery versus treatment based on response, the importance of monitoring pathological assessments, and addressing safety concerns with immunotherapy. The speaker also discusses considerations for adjuvant therapies, emphasizing patient selection and individual risk benefits regarding radiation therapy. Furthermore, the necessity for multidisciplinary care is stressed, shown by improved outcomes with combined specialties. The session concludes with insights into emerging research and a community initiative for skin cancer clinicians and patients to foster support and information sharing.