Vishal Anil Patel, MD

Systemic therapy for CSCC is evolving toward earlier use, combination and de-escalation strategies, and biomarker-driven personalization to improve outcomes and reduce toxicity.

Multidisciplinary collaboration is essential in managing high-risk CSCC, helping clinicians overcome logistical barriers to deliver coordinated, individualized care.

Neoadjuvant immunotherapy is expanding treatment options in CSCC by shrinking complex tumors, improving surgical outcomes, and potentially enhancing long-term disease control.

Immunotherapy—particularly PD-1 inhibition with cemiplimab—is reshaping CSCC care by expanding into neoadjuvant and adjuvant settings and offering durable disease control in high-risk patients.

Clinicians should consider systemic immunotherapy earlier in CSCC—especially in moderate- to high-risk cases—using a multidisciplinary, patient-centered approach to guide treatment decisions.

Updated guidelines for CSCC introduce more granular risk stratification and emphasize deeper biopsies to improve staging accuracy and guide decisions about surgery and systemic therapy.

NCCN guideline updates for CSCC emphasize immunotherapy as a cornerstone across disease stages, expanding its role from advanced disease into neoadjuvant and adjuvant settings.