Neoadjuvant Immunotherapy for Periauricular Cutaneous Squamous Cell Carcinoma

Area of Science:

• Oncology
• Surgical Oncology
• Immunotherapy

Background:

• Standard treatment for advanced periauricular cutaneous squamous cell carcinoma (pCSCC) involves surgery and adjuvant radiation.
• Neoadjuvant immunotherapy has shown promise with high pathologic response rates in resectable pCSCC.

Purpose of the Study:

• To evaluate the impact of neoadjuvant immunotherapy on survival outcomes in patients with advanced resectable pCSCC.
• To compare event-free survival (EFS) and overall survival (OS) between patients receiving neoadjuvant immunotherapy followed by surgery and those undergoing upfront surgery.

Main Methods:

• Retrospective review of patients with pathologically confirmed pCSCC treated with curative-intent surgery from 2005-2025.
• Age- and stage-matched comparison of patients who received neoadjuvant immunotherapy before surgery versus those who had upfront surgery.
• Kaplan-Meier method used to estimate EFS and OS.

Main Results:

• 85 patients included: 24 (28.2%) received neoadjuvant immunotherapy, 61 (71.7%) had upfront surgery.
• Neoadjuvant immunotherapy group showed significantly longer median EFS (5.9 vs. 3.4 years; p=0.02) and OS (not met vs. 4.4 years; p=0.031).
• Two-year EFS was higher in the neoadjuvant group (87%) compared to the upfront surgery group (55%).

Conclusions:

• Neoadjuvant immunotherapy demonstrates improved survival outcomes for advanced resectable pCSCC.
• Supports the inclusion of this patient group in future randomized clinical trials.
• Highlights the potential of immunotherapy in managing advanced pCSCC.