Cutaneous squamous cell carcinoma: state of the art, perspectives and unmet needs

Area of Science:

• Dermatology and Oncology
• Cutaneous Oncology
• Cancer Treatment Guidelines

Background:

• Squamous cell carcinoma of the skin (cSCC) is a prevalent cancer in Caucasian populations, representing 20% of all cutaneous tumors.
• Updated S3 guidelines from the German Guideline Program in Oncology (2022) provide current management strategies for cSCC.

Purpose of the Study:

• To summarize the diagnostic and therapeutic approaches for cutaneous squamous cell carcinoma (cSCC) based on current guidelines.
• To highlight recommended treatments for localized and advanced/metastatic cSCC, including surgical, radiation, and systemic therapies.
• To identify areas requiring further research in cSCC management.

Main Methods:

• Diagnosis relies on clinical examination, with excision and histological confirmation for suspicious lesions.
• Primary treatment involves surgical excision with complete margin assessment.
• Risk stratification guides surveillance, incorporating dermatological checks and sonography for high-risk patients.

Main Results:

• Surgical excision is the standard treatment for localized cSCC.
• Cemiplimab is the recommended first-line treatment for locally advanced or metastatic cSCC in Europe.
• Alternative treatments for advanced cSCC include chemotherapy, EGFR inhibitors, or palliative radiation therapy when cemiplimab is contraindicated.

Conclusions:

• Current guidelines emphasize surgical excision for cSCC diagnosis and treatment, with adjuvant radiation for high-risk cases.
• Immune checkpoint inhibitors represent a significant advancement for advanced cSCC, though research continues for resistant cases and specific patient groups.
• Future research directions include novel drug combinations, intralesional therapies, and neoadjuvant approaches for cSCC.