Considering Immunotherapy for Cutaneous Squamous Cell Carcinoma - Episode 7
Anna C. Pavlick, DO: For many of the skin cancers that you and I deal with, it really takes a village to take care of the disease. In your perspective, who do you think is really integral in dealing with the management of these carcinomas?
Anthony Rossi, MD, FAAD: That’s a great point. Not all squamous cell carcinomas are created equally, so we like to say there’s a low-risk squamous cell carcinoma and a high-risk squamous cell carcinoma. We try to make that distinction because it helps us divide the management of this. Patients who are at risk for getting these types of skin cancers—the fair-skinned individuals or the patients with a history of tanning or excessive burns or even a family history—should be screened by their dermatologist at least once a year to make sure there are no changing lesions or any changing moles that can predispose them to other skin cancers. We really do like to get them in a regular routine screening pattern. Of course, if they’re going to their regular general practitioner and they see something on one of those exams, then they can be referred appropriately. But it’s also important for the patient just to check their own skin, especially if they’re noticing that there’s a pink spot that’s scaling, that could be the sign of an early precursor lesion that can develop later on into a squamous cell. Those are called actinic keratosis. Those usually start out as these red scaling patches or little spots that happen frequently on the head and neck and in sun-exposed areas.
If that is the case, then going to see your dermatologist is helpful because there are many ways that we can stop those precancers and treat them before they turn into squamous cell carcinomas.
Anna C. Pavlick, DO: Clearly we know that the earlier you catch something, the better the outcome. I would assume that that’s exactly how you feel. If we can get patients to see dermatologists on a regular basis, even patients who may be seeing an oncologist, just to raise awareness that skin lesions are easily manageable when they’re early stage and that this is something that you are critical in helping us to manage.
Many of the therapies that patients are given as oncology patients can sometimes predispose them to early stage skin cancers as well, and I think it’s helpful to have a really united team that works for the patient’s best interest in preventing these things from happening.
Anthony Rossi, MD, FAAD: We do get a lot of referrals from our oncology colleagues because many of those patients are at higher risk for getting a skin cancer because of the immunosuppressive medications that they’re on. We like to say that if they’re caught early, you can actually cure early low-risk squamous cell carcinomas mainly by just cutting them out. The surgical option is very good for these early stage disease and early stage lesions, and that’s really helpful because we can prevent those from spreading if caught early and if managed appropriately with regular surgical excisions.
Anna C. Pavlick, DO: OK. And can you talk a little about the type of excision that gets done for these lesions?
Anthony Rossi, MD, FAAD: For low-risk skin cancers, especially squamous cell carcinoma, we think of the low-risk body types as the arms, the trunk, the torso. These are areas where we can readily excise them just doing a wide local excision for invasive squamous cell carcinoma. If it’s even more superficial and it’s just in situ, meaning just in the top layer of the skin, then we can do some other curative procedures such as scrape and burn or electrodesiccation and curettage. There are also topical chemotherapies that can be used off-label for these types of early lesions or in situ lesions. So we have multiple ways we can treat these in situ lesions early on to prevent them from growing or spreading further.
Transcript Edited for Clarity