Cutaneous squamous cell carcinoma: Management of advanced and high-stage tumors

Abstract

While the majority of cutaneous squamous cell carcinomas (cSCCs) can be treated surgically, the additional work-up and treatments indicated for high-risk cSCC remain undefined. In recent years, improvements in tumor staging systems have allowed for the more accurate stratification of tumors into high- and low-risk categories. This insight, along with the publication of cSCC guidelines, brings us closer to the development of a consensus approach. The second article in this continuing medical education series addresses in question and answer format the most common questions related to advanced and high-stage cSCCs, with a simplified flowchart. The questions include the following: 1) Does my patient have high-risk cSCC?; 2) What is the next step for patients with cSCC and palpable lymphadenopathy?; 3) In patients with no clinically evident lymphadenopathy, who are candidates for lymph node staging?; 4) What forms of radiologic imaging can help detect subclinical lymph node metastases?; 5) What is the role of sentinel lymph node biopsy in cSCC?; 6) Which patients with cSCC need adjuvant radiation therapy?; 7) Is adjuvant chemotherapy an option for patients with high-stage cSCC after surgery?; 8) Are targeted and immunologic therapies an option for advanced cSCC?; 9) How often should I follow up with my patient after he/she has been diagnosed with a high-risk cSCC?; 10) What are the options for chemoprophylaxis in a patient with an increased risk of cSCC?; and 11) What chemopreventive measures can be started in coordination with medical oncology or transplant physicians?

Keywords: 5-fluorouracil; American Joint Commission on Cancer; Brigham and Women's Hospital staging system; CDKN2A; CT; MRI; N1S3 staging; NOTCH1; PD-1; Ras; acitretin; cSCC; capecitabine; cetuximab; chemotherapy; classification; cutaneous squamous cell carcinoma; familial cancer syndromes; high-risk; imiquimod; ingenol mebutate; management; nicotinamide; nivolumab; p53; pembrolizumab; photodynamic therapy; radiation therapy; retinoids; risk factors; sentinel lymph node biopsy; sirolimus; staging.