The first 60 days: Cutaneous squamous cell carcinoma
Cutaneous squamous cell carcinoma is a sun-related skin cancer with over a million US cases a year, almost all cured by removing them. The 2 to 5% that grow deep or spread respond to PD-1 immunotherapy (cemiplimab, pembrolizumab), which is now also given after surgery in high-risk cases; transplant recipients cannot safely receive it. Below, week by week, is what OnCo's record of Cutaneous squamous cell carcinoma says about the first two months: the order is typical, the timing is yours to ask about. Sections appear only where the record has something to say. Orientation, not medical advice.
What happens now
Staging tests establish exactly what and where the cancer is. Everything else follows from the answers.
Ask which of these were tested and what the results were; see the report reader for what each value means.
These specialties appear in the standard of care for this cancer. In most centres they meet weekly as a tumour board to agree each plan; you can ask when yours was discussed and what was decided.
- SurgeonNamed in the standard of care for: Localised low- and high-risk, Locally advanced or metastatic.
- Medical oncologistNamed in the standard of care for: Localised low- and high-risk, High-risk after surgery and radiotherapy, Locally advanced or metastatic, Immunotherapy-ineligible or refractory.
- Clinical oncologist (radiotherapy)Named in the standard of care for: Localised low- and high-risk, Immunotherapy-ineligible or refractory.
A second opinion from a centre that treats many similar cases is normal, not rude; the standard of care tells you what to compare it against.
Each row is a setting from the standard of care, in the order it usually arises. Not all will apply to you; your stage and biomarkers decide which do. The guideline grade, where recorded, says how strong the evidence is.
Excision with margin control or Mohs micrographic surgery; adjuvant radiotherapy for high-risk features (perineural invasion, positive margins); nodal evaluation for very high risk.
Adjuvant cemiplimab (C-POST, 2025: reduced locoregional and distant recurrence).
- 3.Locally advanced or metastaticNCCN category Category 2A (preferred: cemiplimab, pembrolizumab), NCCN Guidelines: Squamous Cell Skin Cancer
Cemiplimab, pembrolizumab or cosibelimab; neoadjuvant cemiplimab for resectable stage II-IV to shrink surgery (51% pCR).
Cetuximab ± radiotherapy, platinum-based chemotherapy, capecitabine; trials of intratumoural agents (RP1) and EGFR ADCs.
Generated from this cancer's standard of care, biomarkers and open problems. Take the group that matches where you are. To tick, add your own and print, open the one-page appointment sheet.
Newly diagnosed
- What is my exact diagnosis, stage, and grade, and which tests established them?Everything else follows from an accurate stage and subtype.
- Which biomarkers have been tested on my tumour (for example BWH and AJCC-8 T stage, Perineural invasion, depth beyond fat, differentiation, Immunosuppression status, Gene-expression prognostic test, PD-L1), and what were the results?These results decide eligibility for targeted therapy, immunotherapy, and trials.
- Which subtype is my cancer, and does that change the recommended treatment?Recognised subtypes for this cancer include Low-risk cSCC, High-risk cSCC, Locally advanced unresectable cSCC.
- Is germline (inherited) genetic testing recommended for me or my family?Inherited variants can change treatment and matter for relatives.
Localised low- and high-risk
- For my situation (localised low- and high-risk), which of the standard options do you recommend and why?Guideline options include: Excision with margin control or Mohs micrographic surgery; adjuvant radiotherapy for high-risk features (perineural invasion, positive margins); nodal evaluation for very high risk.
High-risk after surgery and radiotherapy
- For my situation (high-risk after surgery and radiotherapy), which of the standard options do you recommend and why?Guideline options include: Adjuvant cemiplimab (C-POST, 2025: reduced locoregional and distant recurrence).
- Am I a candidate for Cemiplimab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Locally advanced or metastatic
- For my situation (locally advanced or metastatic), which of the standard options do you recommend and why?Guideline options include: Cemiplimab, pembrolizumab or cosibelimab; neoadjuvant cemiplimab for resectable stage II-IV to shrink surgery (51% pCR).
- Am I a candidate for Cemiplimab, Pembrolizumab, Cosibelimab, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Immunotherapy-ineligible or refractory
- For my situation (immunotherapy-ineligible or refractory), which of the standard options do you recommend and why?Guideline options include: Cetuximab ± radiotherapy, platinum-based chemotherapy, capecitabine; trials of intratumoural agents (RP1) and EGFR ADCs.
- Am I a candidate for Cetuximab, Carboplatin, Vusolimogene oderparepvec, and what side effects should I expect?Knowing the expected toxicities helps you plan work, family, and supportive care.
Any stage
- Are there clinical trials I could join, for example of Cemiplimab, Cosibelimab, Vusolimogene oderparepvec, HMBD-001?Trials are how the next standard of care is set; asking early keeps options open.
- Would a second opinion at a high-volume centre change anything, and can you help arrange it?Rare or high-stakes decisions benefit from a centre that treats many similar patients.
- What supportive care (symptom control, nutrition, exercise, mental health, financial help) is available from the start?Supportive care improves quality of life and helps patients complete treatment.
- I read that “Organ-transplant recipients: high incidence, no safe immunotherapy”. How does that affect my plan?Open problems are where trials and second opinions matter most.
- I read that “Who needs adjuvant therapy: gene-expression tests vs clinicopathologic staging”. How does that affect my plan?Open problems are where trials and second opinions matter most.
Trials open now for this cancer in OnCo, largest phase first. Joining a trial is a decision like any other: ask what the comparison arm is, whether a placebo is used, and what happens if you leave. The cancer page searches ClinicalTrials.gov live for more.
- Study of Intralesional Cemiplimab in Adult Patients With Early Stage Cutaneous Squamous Cell CarcinomaPhase 3 · recruiting · NCT06585410A Phase 3 Randomized Study of Intralesional Cemiplimab Versus Primary Surgery in Participants With Early Stage Cutaneous Squamous Cell Carcinoma (CSCC)
- Study Evaluating Cemiplimab Alone and Combined With RP1 in Treating Advanced Squamous Skin CancerPhase 2 · active · NCT04050436A Randomized, Controlled, Open-Label, Phase 2 Study of Cemiplimab as a Single Agent and in Combination With RP1 in Patients With Advanced Cutaneous Squamous Cell Carcinoma
- A Phase Ib/II Study of an Anti-HER3 Antibody, HMBD-001, With Cetuximab +/- Docetaxel in Advanced Squamous Cell CancersPhase 1/2 · recruiting · NCT05910827A Phase Ib/II Study to Evaluate HMBD-001 in Combination With Cetuximab, With or Without Docetaxel in Participants With Advanced Squamous Cell Carcinomas
- A Study of IDP-001 in Advanced or Metastatic Solid TumorsPhase 1/2 · recruiting · NCT07602842A Phase 1/2 Open-label Study of IDP-001 in Advanced or Metastatic Squamous Cell Lung Cancer and Other Solid Tumors
- An Open-label Study Using ASP-1929 Photoimmunotherapy in Combination With Anti-PD1 Therapy in EGFR Expressing Advanced Solid TumorsPhase 1/2 · active · NCT04305795An Open-label Study Using ASP-1929 Photoimmunotherapy in Combination With Anti-PD1 Therapy in EGFR Expressing Advanced Solid Tumors
Much of what helps in the first weeks is free if you know to ask: testing, helplines, rides and lodging, second opinions, trial travel.
- Cutaneous squamous cell carcinoma: the full pageCutaneous squamous cell carcinoma is a sun-related skin cancer with over a million US cases a year, almost all cured by removing them. The 2 to 5% that grow deep or spread respond to PD-1 immunotherapy (cemiplimab, pembrolizumab), which is now also given after surgery in high-risk cases; transplant recipients cannot safely receive it.
- One-page appointment sheetYour questions, the words you may hear, what to bring, and space for the answers. Print it.
- Treatment sequencingWhich treatment tends to follow which, line by line.
- NavigatorStandard of care for your stage, what you have tried, and trials near you.
- Tumour mutational burden (TMB): How many mutations a tumour has.
- Pathologic complete response (pCR): No invasive cancer left in the breast and lymph nodes when the surgeon removes the tissue after pre-surgery treatment.
- Immune-related adverse events (irAEs): Immune-related adverse events (irAEs) are the autoimmune side effects of checkpoint inhibitors: colitis, thyroid problems, rash, hepatitis, pneumonitis.
Every term links to the glossary.