Updates in Cutaneous Oncology: Cutaneous Squamous Cell Carcinoma

This update on cutaneous squamous cell carcinoma (cSCC) focuses on high-risk cases, covering advancements in staging systems, diagnostic strategies, and treatment approaches. The 8th edition AJCC staging is emphasized, particularly T staging, which categorizes tumors based on size and invasion characteristics. High-risk factors include tumor size greater than 2 cm, perineural invasion, and deep invasion. The talk reviews comparative studies between AJCC and Brigham Women's Hospital staging systems, noting that the latter identifies high-risk cases with greater specificity. It highlights the importance of staging for prognostic relevance and treatment planning, including sentinel lymph node biopsy and imaging to detect metastasis. Current guidelines for when to perform these procedures remain inconsistent. The potential role of gene expression profiling in risk stratification is discussed, showing promise in determining which patients exhibit high-risk characteristics beyond conventional staging. Immunotherapy with checkpoint inhibitors, such as semiplimab and pembrolizumab, represents new therapeutic options, particularly for organ transplant recipients who may face heightened risks. Overall, multidisciplinary management is deemed critical for high-risk cSCC patients, advocating for collaboration across specialties, and continued assessment of both systemic therapies and non-invasive strategies to reduce future skin cancer risks.