# Cutaneous squamous cell carcinoma

Source: https://onco.cc/cancers/cutaneous-scc/  
OnCo record `cutaneous-scc` (Cancer). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

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.

## Summary

Cutaneous squamous cell carcinoma (cSCC) arises from UV-damaged keratinocytes and has one of the highest mutational burdens of any cancer (TP53, NOTCH1/2, CDKN2A). Immunosuppression (transplant recipients have 65-100-fold higher risk) and chronic wounds are other causes. Most tumours are cured by excision or Mohs surgery; risk of recurrence and metastasis is stratified by BWH/AJCC-8 staging (depth, perineural invasion, differentiation, immunosuppression), with radiotherapy for high-risk or inoperable disease.

Cemiplimab (EMPOWER-CSCC-1, 2018) was the first systemic therapy approved for advanced cSCC, with ~45-50% response and durable disease control; pembrolizumab (KEYNOTE-629, 2020) and cosibelimab (anti-PD-L1, December 2024) followed. Neoadjuvant cemiplimab produced pathological complete response in 51% of stage II-IV disease (Gross, NEJM 2022), and the C-POST trial (2025) showed adjuvant cemiplimab after surgery and radiotherapy cut recurrence in high-risk patients, leading to an adjuvant approval. EGFR antibodies (cetuximab) and chemotherapy are reserved for immunotherapy-ineligible patients such as organ-transplant recipients.

Open: managing transplant recipients (checkpoint inhibitors cause graft rejection), chemoprevention (nicotinamide, acitretin), and the burden of field cancerisation.

## Fields

- Kind: Cancer
- Last checked: 2026-09-25
- Also known as: cSCC; Squamous Cell Carcinoma of the Skin; Squamous cell skin cancer; Squamous cell carcinoma of the skin; SCC of the skin; Keratinocyte carcinoma, squamous type; Cutaneous SCC; Epidermoid carcinoma of skin
- Tags: gap-fill; skin
- Group: skin
- Burden: Second most common skin cancer; over one million cases per year in the US, almost all cured by removal; about 2-5% metastasise, which still amounts to several thousand deaths a year and is where PD-1 immunotherapy now helps.
- Subtypes: Low-risk cSCC (small, well-differentiated, no perineural invasion); High-risk cSCC (BWH T2b-T3; deep invasion, perineural invasion, poorly differentiated); Locally advanced unresectable cSCC; Metastatic cSCC; cSCC in organ-transplant recipients / immunosuppressed; Keratoacanthoma and in situ (Bowen) disease; No special type, also called classic, which is the default when none of the high-risk subtype features is present (RCPath G124); High-risk subtypes named by UK national guidelines and NICE: acantholytic, desmoplastic (more than 30 percent desmoplastic stroma) and spindle cell or sarcomatoid; Adenosquamous carcinoma, high risk to WHO; basaloid squamous cell carcinoma, poorly differentiated by definition and distinguished from basal cell carcinoma by BerEP4 and EMA staining; Squamous cell carcinoma with adjacent Bowen's disease, usually counted as a high-risk variant; By grade rather than type: well, moderately and poorly differentiated, graded from the most poorly differentiated region present; By origin: from surface epidermis or from follicular epithelium, either of which can be in situ or invasive; Bowen's disease, squamous cell carcinoma in situ, which has its own page; keratoacanthoma, which the WHO treats as a keratoacanthomatous type of this cancer and which is a glossary term here
- Biomarkers: BWH and AJCC-8 T stage; Perineural invasion, depth beyond fat, differentiation; Immunosuppression status; Gene-expression prognostic test (40-GEP, DecisionDx-SCC); PD-L1 (not required); TMB (very high); Grade: well, moderately or poorly differentiated, assigned from the most poorly differentiated region irrespective of percentage (RCPath G124); Subtype: acantholytic, desmoplastic, spindle cell or adenosquamous, each a high-risk feature on its own; Thickness over 4 mm, and level of invasion reaching or passing the subcutaneous fat; Perineural invasion and lymphovascular invasion; Margins: involved at 0 mm, or clear but under 1 mm; Immunosuppression, which is not on the slide and is added by the clinician or the multidisciplinary team; UICC pathological T category, and separately the Brigham and Women's Hospital factor count where a clinician uses it

## Sections of this record

The page is a hub with ten sections in reading order; large sections have their own page. The same plan as JSON: https://onco.cc/api/v1/cancers/cutaneous-scc/sections.json

- Overview (on the hub): The TL;DR, the family this cancer belongs to, the organ, who gets it and what the state of the art is. https://onco.cc/cancers/cutaneous-scc/#overview [2 subtypes, 4 state-of-the-art points]
- Types and stages (on the hub): Anatomy, the subtypes and how they differ, how it is staged, and where advanced disease spreads. https://onco.cc/cancers/cutaneous-scc/#what-it-is [15 subtypes, 7 staging notes]
- Symptoms and diagnosis (on the hub): How this cancer shows itself, how the diagnosis is confirmed, and the biomarkers clinicians test for. https://onco.cc/cancers/cutaneous-scc/#finding-it [5 symptoms, 13 biomarkers]
- Treatment (on the hub): The standard of care by setting, the medicines, surgery and radiotherapy named in it, and the regimens behind them. https://onco.cc/cancers/cutaneous-scc/#treating-it [10 settings, 1 regimen, 7 decisions with options]
- Trials and papers (on the hub): Trials recruiting now, the landmark trials, the trials held by this cancer's subtypes, the key papers and what they mean, the latest literature, and the milestones year by year. https://onco.cc/cancers/cutaneous-scc/#evidence [19 trials, 2 key papers, 12 milestones]
- Biology and targets (on the hub): The molecular landscape: the targets and how often each appears, the pathways, the mechanics stages and the preclinical models. https://onco.cc/cancers/cutaneous-scc/#science [13 targets, 3 pathways]
- Countries and centres (own page): Cases by country, the UK and NHS pathway and other country lenses, the expert centres with trials on record, and the centres named on this cancer's subtypes. https://onco.cc/cancers/cutaneous-scc/where-you-are/ [5 centres, 1 centre in the subtypes, 10 UK centres]
- Decisions and support (on the hub): The decisions you may face, the aids that walk through them, the warnings on record, the first sixty days and the questions to ask. https://onco.cc/cancers/cutaneous-scc/#living-with-it [10 questions, 6 red cards]
- Pipeline and open problems (own page): Everything in development, the medicines held by this cancer's subtypes, the open problems and what is being done about them, the roadmaps, and what changed on this record. https://onco.cc/cancers/cutaneous-scc/coming/ [12 medicines, 2 medicines in the subtypes, 18 trials, 12 open problems]
- Data (own page): Every connected record, the notes, the JSON, Markdown and RDF twins, and where the record came from and when it was checked. https://onco.cc/cancers/cutaneous-scc/data/ [118 connected records, 9 notes]

## Standard of care

- Localised low- and high-risk: Excision with margin control or Mohs micrographic surgery; adjuvant radiotherapy for high-risk features (perineural invasion, positive margins); nodal evaluation for very high risk. ([IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/))
- High-risk after surgery and radiotherapy: Adjuvant cemiplimab (C-POST, 2025: reduced locoregional and distant recurrence). ([Cemiplimab](https://onco.cc/drugs/cemiplimab/))
- Locally advanced or metastatic: Cemiplimab, pembrolizumab or cosibelimab; neoadjuvant cemiplimab for resectable stage II-IV to shrink surgery (51% pCR). ([Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Cosibelimab](https://onco.cc/drugs/cosibelimab/))
- Immunotherapy-ineligible or refractory: Cetuximab ± radiotherapy, platinum-based chemotherapy, capecitabine; trials of intratumoural agents (RP1) and EGFR ADCs. ([Cetuximab](https://onco.cc/drugs/cetuximab/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Vusolimogene oderparepvec](https://onco.cc/drugs/vusolimogene-oderparepvec/))
- Which squamous cell carcinomas are the dangerous ones: Most of these are cured by removing them, and the British Association of Dermatologists says exactly that: most squamous cell carcinomas are low-risk skin cancers and can be cured, and a small number recur locally or spread to the lymph nodes or elsewhere. The useful thing is to know which is which, and two cohorts did the work. In a prospective study of 615 patients followed for a median of 43 months, no tumour 2.0 mm thick or less metastasised at all; metastases occurred in 12 of 318 tumours between 2.1 and 6.0 mm thick (4 percent) and in 14 of 90 thicker than 6.0 mm (16 percent). On multivariate analysis the factors that mattered were increasing thickness (hazard ratio 4.79), immunosuppression (4.32), a location on the ear (3.61) and increasing width (2.22); local recurrence was driven by thickness and by desmoplastic growth (16.11). In a ten-year cohort of 985 patients with 1,832 tumours, local recurrence occurred in 4.6 percent, nodal metastasis in 3.7 percent and death from the cancer in 2.1 percent, and the independent predictors of nodal spread and of death were a diameter of at least 2 cm, poor differentiation, invasion beyond the fat, and an ear or temple location, with perineural invasion also associated with death from the cancer. Those are the words to look for on your pathology report, and they are the ones that decide whether radiotherapy after surgery, imaging or a specialist team referral are discussed. Perineural invasion comes in two forms and the distinction changes the outlook: found only on the slide with no symptoms, or clinically evident through pain, altered sensation or weakness, which is the worse kind and the reason those symptoms are on the red cards. Treatment is surgical: the BAD says removal with a margin of normal skin under local anaesthetic, closed with stitches or sometimes a graft, with curettage and cautery for some lesions and Mohs in some circumstances, and radiotherapy as an alternative. It is the BAD's transplant leaflet rather than its squamous cell one that says when radiotherapy is chosen: for skin cancers that are difficult to remove with surgery or have a high risk of returning after it. A pooled analysis of observational studies put local recurrence at 3.0 percent after Mohs, 5.4 percent after standard excision and 6.4 percent after radiotherapy, while warning that the tumours sent to each were not comparable and that photodynamic therapy, at 26.4 percent, is not a treatment for an invasive squamous cell carcinoma. ([Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/), [Wide local excision](https://onco.cc/terms/wide-local-excision/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/), [Curettage and cautery](https://onco.cc/terms/curettage-and-cautery/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Skin cancer after an organ transplant](https://onco.cc/terms/skin-cancer-after-organ-transplant/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/))
- Follow-up, the lymph nodes, and the chance of a second one: Follow-up after a squamous cell carcinoma is where the UK sources openly disagree, and it is better to know that than to be surprised by it. The BAD patient leaflet says current guidelines are that people at low risk of a second one do not need a specialist following them up, and that higher-risk cancers should be followed up regularly for one to two years by the specialist or their team. Cancer Research UK says a high-risk squamous cell carcinoma might mean appointments every four to six months for at least five years, and that a low-risk one might mean a single appointment and then none. Ask which your team is doing and why, because the answer tells you how they have classified your cancer. What is checked is your skin, all of it, and the lymph nodes nearest the original cancer; Cancer Research UK says tests may include a skin biopsy, an ultrasound or a CT scan, and that surgery to remove lymph nodes is uncommon for these cancers but is done if a squamous cell carcinoma has spread to them, which for a scalp or face primary means the nodes on the same side of the neck. Then the second question, which is more likely than recurrence. In the meta-analysis of 17 studies the three-year cumulative risk of a further squamous cell carcinoma after a first was 18 percent, at least ten times the general population rate, and the risk of also developing a basal cell carcinoma was about the same as for someone whose first cancer was a basal cell carcinoma. The BAD's leaflet puts it higher over five years: about 40 percent after a low-risk squamous cell carcinoma and possibly as high as 80 percent after a higher-risk one. This is why a dermatologist may treat skin that does not look like cancer to you: the BAD says treating areas of scaly sun damage, meaning actinic keratosis and Bowen disease, may reduce the risk of a squamous cell carcinoma, and describes large areas of such damage as field change. Three symptoms are worth a phone call rather than a wait: a new scaly or crusted lump that is growing, especially a painful one; a lump in the lymph nodes of the neck, armpit or groin on the side of a previous squamous cell carcinoma; and new numbness, tingling, burning pain or weakness in the face near where one was treated. ([The next skin cancer: second primaries after a keratinocyte cancer](https://onco.cc/terms/second-primary-skin-cancer/), [Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/), [Sun protection after a skin cancer diagnosis](https://onco.cc/terms/sun-protection-after-skin-cancer/), [Skin cancer after an organ transplant](https://onco.cc/terms/skin-cancer-after-organ-transplant/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/), [Field cancerisation](https://onco.cc/pathways/field-cancerisation/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/))
- Radiotherapy after surgery, and what not to add to it: For high-risk disease, surgery followed by postoperative radiotherapy of 60 to 66 Gy. The habit of adding chemotherapy, carried over from head and neck oncology, was tested in TROG 05.01: 321 patients randomised to postoperative radiotherapy with or without weekly carboplatin, with freedom from locoregional relapse at five years of 87 against 83 per cent, hazard ratio 0.84 (0.46 to 1.55, p=0.58), and no difference in disease-free or overall survival. Carboplatin should not be added. The control arm is the number to carry forward: surgery and radiotherapy alone controlled 83 per cent of these tumours locoregionally at five years, and only 7 per cent failed first at a distant site. ([TROG 05.01 (chemotherapy added to radiotherapy after surgery for high-risk skin squamous cell carcinoma)](https://onco.cc/trials/trog-05-01/), [Radiotherapy for skin cancer](https://onco.cc/terms/radiotherapy-for-skin-cancer/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/))
- Before surgery, when the operation would be disfiguring: Up to four doses of cemiplimab before an operation planned with curative intent. In 79 patients with resectable stage II to IV disease, a pathological complete response, meaning no viable tumour cells anywhere in the specimen on central review, was found in 40 (51 per cent, 39 to 62) and a pathological major response in a further 10 (13 per cent). Imaging understated it, at 68 per cent objective response. Grade 3 or higher adverse events occurred in 18 per cent. What the trial does not answer is whether the surgery can then be reduced or omitted, because everyone was resected; that is the next question and it is the same one being asked in rectal and bladder cancer. ([Neoadjuvant cemiplimab for resectable stage II to IV skin squamous cell carcinoma](https://onco.cc/trials/neoadjuvant-cemiplimab-cscc/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [The margin in skin cancer surgery](https://onco.cc/terms/surgical-margins-keratinocyte-cancer/))
- The transplant recipient and the immunosuppressed patient: A group with 65 to 100 times the ordinary risk, tumours that are multiple and far more likely to spread, and almost no evidence, because every registration trial excluded them. Three levers. Switching immunosuppression: TUMORAPA randomised 120 kidney transplant recipients who had already had one of these cancers and found new squamous cell carcinomas in 22 per cent after a switch to sirolimus against 39 per cent continuing a calcineurin inhibitor (relative risk 0.56, 0.32 to 0.98), at the price of 60 serious adverse events against 14 and 23 per cent stopping the drug. Chemoprevention: acitretin and nicotinamide, with the nicotinamide effect not reproduced in transplant recipients. Immunotherapy, long refused because of the risk to the graft: a twelve-patient phase 1 study that cross-tapered to a mammalian target of rapamycin inhibitor and pulsed prednisone around each cycle reported no rejection and no graft loss, with responses in 5 of 11 evaluable patients. That is the whole prospective evidence base. ([Skin cancer after an organ transplant](https://onco.cc/terms/skin-cancer-after-organ-transplant/), [TUMORAPA (switching from a calcineurin inhibitor to sirolimus after a transplant skin cancer)](https://onco.cc/trials/tumorapa/), [Cemiplimab for kidney transplant recipients with advanced skin squamous cell carcinoma](https://onco.cc/trials/cemiplimab-kidney-transplant-cscc/), [Acitretin](https://onco.cc/drugs/acitretin/), [Nicotinamide](https://onco.cc/drugs/nicotinamide/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/))
- What is available in England: NICE technology appraisal TA802 recommendation 1.1 recommends cemiplimab for metastatic or locally advanced cutaneous squamous cell carcinoma in adults when curative surgery or curative radiotherapy is not suitable, only if it is stopped at 24 months or earlier on progression and the company supplies it under the commercial arrangement. It replaced TA592, which had recommended it within the Cancer Drugs Fund. That single appraisal is the extent of NICE's appraisal guidance for this disease, though not of its guidance: pembrolizumab and cosibelimab have not been appraised for it, and the adjuvant indication that C-POST supports has no appraisal either, while HTG333 on electrochemotherapy, HTG99 on photodynamic therapy, NG12 recommendation 1.7.4 and QS130 all cover it. ([Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Cosibelimab](https://onco.cc/drugs/cosibelimab/), [C-POST (cemiplimab after surgery and radiotherapy for high-risk skin squamous cell carcinoma)](https://onco.cc/trials/c-post/))

## State of the art

- PD-1 blockade produces durable responses in about half of advanced cSCC, one of the best response rates of any solid tumour, explained by extreme UV mutational burden.
- Neoadjuvant cemiplimab (51% pCR) is redefining surgery for large tumours; adjuvant cemiplimab (C-POST) is the first to reduce recurrence after surgery and radiation.
- Cosibelimab adds an anti-PD-L1 option with a different toxicity profile.
- Transplant recipients remain the hardest group: immunotherapy risks graft loss; mTOR-inhibitor switching and acitretin are the preventive levers.

## Open problems

- Organ-transplant recipients: high incidence, no safe immunotherapy.
- Who needs adjuvant therapy: gene-expression tests vs clinicopathologic staging.
- Field cancerisation and multiple primaries in the elderly.
- Access to Mohs surgery and dermatology capacity.
- The two staging systems disagree about who is high risk and neither side has conceded. The anatomical systems place most tumours and most poor outcomes in the same low categories; the alternative built to fix that has been validated only in single-centre cohorts and the Royal College of Pathologists has published its objection to the risk bands derived from it. The decision this is supposed to inform, who needs nodal assessment or treatment after surgery, is being made in its absence.
- Incidence is still rising while basal cell carcinoma has levelled off. Age-standardised rates in England rose 6.1 percent a year from 2013 to 2015 and 2.3 percent a year from 2015 to 2019 on the annual counting method, and continued to rise in people under 60 and over 80 after plateauing in the middle age groups. Non-melanoma skin cancer mortality rose about 4 percent a year over the same period.
- The people at highest risk are the ones with the fewest options. Immunosuppression is a high-risk feature that no pathologist can see and that transplant recipients cannot simply stop, and it is added to the risk assessment clinically rather than measured.
- The grading rule is strict and its reproducibility is untested at scale. A tumour is graded by its most poorly differentiated focus however small, which is defensible on safety grounds and means the grade depends on how much of the tumour was examined.
- The counting problem applies here too, in a smaller but still large form: the annual counting method finds 42 percent more squamous cell carcinomas than the lifetime-first rule and still misses about 2 per 100 patients, and Scotland, which registers every tumour, is the only part of the UK whose figures are not affected.
- Solid organ transplant recipients have 65 to 100 times the risk of this cancer and their whole prospective evidence base is one randomised trial of 120 patients and one phase 1 study of twelve. The gap is a consequence of an eligibility criterion rather than of biology.
- Neoadjuvant cemiplimab leaves no viable tumour in half of the specimens, but every patient in the trial was operated on anyway, so nobody knows whether the surgery can be reduced or omitted after a complete response.
- There is no NICE appraisal of adjuvant cemiplimab, of pembrolizumab or of cosibelimab in this disease, so the only routinely funded systemic option in England is cemiplimab for advanced disease under TA802, stopped at 24 months.

## Notes

- Cutaneous squamous cell carcinoma, the dangerous minority and the follow-up: This is orientation from public patient pages, guidelines and the trials themselves, not advice for your case: your own team's instructions and the number they gave you come first, and no figure on this page is a prediction about you. The thickness thresholds come from a prospective study of 615 patients with a median follow-up of 43 months and the outcome rates from a cohort of 985 patients at one Boston hospital followed for a median of 50 months. They describe those cohorts. Nothing here is a prognosis for a reader.
- The disagreement between the British Association of Dermatologists (regular follow-up for one to two years for higher-risk disease) and Cancer Research UK (every four to six months for at least five years) is left visible rather than averaged away, because a reader who has been told one of those two is better served by knowing the other exists.
- What this page does not carry: cemiplimab, pembrolizumab, cosibelimab and the management of locally advanced and metastatic disease, which belong to the advanced cutaneous squamous cell carcinoma record; and the face, Mohs as a day, the sun, the mind and immunosuppression, which are written once on the skin cancer family page.
- Every number on this page rests on a counting rule. UK registration long recorded only the first squamous cell carcinoma in a person's lifetime; counting one per person per year instead found 42 percent more over 2013 to 2022 in England, and still misses about 2 tumours per 100 patients. Scotland is the exception and registers every squamous cell carcinoma manually, which is why its figures and England's are not directly comparable. The whole group is excluded from the UK's headline cancer total (see `keratinocyte-cancer-counting`).
- How common it is. About 25 in every 100 skin cancers, which is how Cancer Research UK words it; its basal cell figure of 75 in every 100 is worded against non-melanoma skin cancers, so the two sentences do not share a denominator. In England the registered rate in 2019 was 85.24 per 100,000 person-years; on the annual counting method it was 102 per 100,000 in 2022. Across the UK the annual-method estimate is 50,582 a year for 2016 to 2018. Rates are about 13 to 14 times higher in the White ethnic group than in the Asian or Black groups in England (Ahmed 2026).
- Where this cancer comes from, and why people get more than one. It arises from keratinocytes that have accumulated ultraviolet damage, usually in skin that has had decades of it, and it is often surrounded by a field of the same damage that is visible as actinic keratoses. That field is why a person who has one is likely to have another, and why treatment is sometimes aimed at an area rather than a lesion. The other routes to it are the same damage from a different source: chronic wounds and old burns and scars, human papillomavirus at some sites, and, most powerfully, long-term immunosuppression.
- Why the report gives both a subtype and a grade, and what each is for. The subtype says what shape the tumour grows in and is mostly a yes-or-no question about four named high-risk patterns; if none is present the report says no special type. The grade says how much the cells still look like skin, on three levels, and is taken from the worst area found. Either one alone can put a tumour into the high-risk group, which is the point: they are describing different ways of being dangerous.
- What the word spreading actually means here, and how likely it is. Cancer Research UK states that these cancers do not often spread, and that when they do it is usually to the deeper layers of the skin, then to nearby lymph nodes, and only rarely beyond. That is why nodal assessment and treatment after surgery are reserved for the small high-risk group, and why so much of the argument about staging is really an argument about how to find that group without treating everybody.
- The word keratoacanthoma on a report. WHO terminology treats keratoacanthoma as synonymous with invasive squamous cell carcinoma of keratoacanthomatous type, and the UK dataset records that no single criterion reliably distinguishes the two, so the diagnosis rests on the whole clinical and pathological picture. The dataset also advises avoiding the term in immunosuppressed people, in large lesions and in subungual sites, because those behave more aggressively. Anyone whose report carries the word is on the right page here.

## Sources

- Wikipedia: https://en.wikipedia.org/wiki/Squamous-cell_carcinoma_of_the_skin
- NCCN Guidelines: Squamous Cell Skin Cancer: https://www.nccn.org/guidelines/guidelines-detail?category=1&id=1465
- C-POST (NEJM 2025): https://doi.org/10.1056/NEJMoa2502449
- NCI PDQ: skin cancer: https://www.cancer.gov/types/skin/patient/skin-treatment-pdq
- Brantsch et al., analysis of risk factors determining prognosis of cutaneous squamous-cell carcinoma: prospective study of 615 patients (Lancet Oncology 2008): https://doi.org/10.1016/S1470-2045(08)70178-5
- Schmults et al., factors predictive of recurrence and death from cutaneous squamous cell carcinoma: 10-year, single-institution cohort study of 985 patients (JAMA Dermatology 2013): https://doi.org/10.1001/jamadermatol.2013.2139
- Lansbury et al., interventions for non-metastatic squamous cell carcinoma of the skin: systematic review and pooled analysis of observational studies (BMJ 2013): https://doi.org/10.1136/bmj.f6153
- Marcil and Stern, risk of developing a subsequent non-melanoma skin cancer in patients with a history of non-melanoma skin cancer: review and meta-analysis (Arch Dermatol 2000): https://doi.org/10.1001/archderm.136.12.1524
- Morecroft et al., immunotherapy and radiation for clinical perineural invasion in cutaneous squamous cell carcinoma (Cancers 2025): https://doi.org/10.3390/cancers17243921
- British Association of Dermatologists: squamous cell carcinomas, patient information leaflet (updated April 2022; the leaflet gives its own next review date as April 2025 and no newer version exists at this address or at bad.org.uk): https://www.skinhealthinfo.org.uk/condition/squamous-cell-carcinomas/
- British Association of Dermatologists and BSSCII: skin cancer advice for organ transplant recipients, patient information leaflet (June 2024): https://www.skinhealthinfo.org.uk/condition/skin-cancer-in-organ-transplant-recipients/
- Cancer Research UK: follow-up after non-melanoma skin cancer treatment: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/follow-up-appointments
- Cancer Research UK: types of surgery for non-melanoma skin cancer: https://www.cancerresearchuk.org/about-cancer/skin-cancer/treatment/surgery/treatment-surgery-types
- Krynitz et al., risk of skin cancer and other malignancies in kidney, liver, heart and lung transplant recipients 1970 to 2008, Swedish population-based study of 10,476 recipients (Int J Cancer 2013): https://doi.org/10.1002/ijc.27765
- Garrett et al., incidence of and risk factors for skin cancer in organ transplant recipients in the United States, 10,649 recipients (JAMA Dermatology 2017): https://doi.org/10.1001/jamadermatol.2016.4920
- Royal College of Pathologists G124: dataset for histopathological reporting of primary invasive cutaneous squamous cell carcinoma and regional lymph nodes, version 4, February 2019 (Slater and Barrett): https://www.rcpath.org/resourceLibrary/g124datasetsquamous-pdf.html
- Cancer Research UK: squamous cell carcinoma of the skin: https://www.cancerresearchuk.org/about-cancer/skin-cancer/types/squamous-cell-carcinoma
- Keohane et al., British Journal of Dermatology 2021;184(3):401 to 414: British Association of Dermatologists guidelines for the management of people with cutaneous squamous cell carcinoma 2020: https://doi.org/10.1111/bjd.19621
- Royal College of Pathologists appendix A: UICC TNM 9 pathological staging of primary cutaneous carcinoma (squamous cell): https://www.rcpath.org/resourceLibrary/squamous-cell-tnm9.html
- Jambusaria-Pahlajani et al., JAMA Dermatology 2013;149:402 to 410: evaluation of AJCC tumour staging for cutaneous squamous cell carcinoma and a proposed alternative tumour staging system (256 primary high-risk tumours; the derivation of the Brigham and Women's Hospital system): https://doi.org/10.1001/jamadermatol.2013.2456
- Karia et al., Journal of Clinical Oncology 2014;32:327 to 334: evaluation of AJCC, UICC and Brigham and Women's Hospital tumour staging for cutaneous squamous cell carcinoma (1,818 primary tumours, 2000 to 2009): https://doi.org/10.1200/jco.2012.48.5326
- Ruiz, Karia, Besaw and Schmults, JAMA Dermatology 2019;155:819 to 825: performance of the AJCC staging manual 8th edition versus the Brigham and Women's Hospital tumour classification system for cutaneous squamous cell carcinoma: https://doi.org/10.1001/jamadermatol.2019.0032
- Karia et al., JAMA Dermatology 2018;154:175 to 181: comparison of tumour classifications for cutaneous squamous cell carcinoma of the head and neck in the 7th versus the 8th edition of the AJCC staging manual (680 tumours in 459 patients): https://doi.org/10.1001/jamadermatol.2017.3960
- Cancer Research UK: survival for non-melanoma skin cancer (net survival for skin squamous cell carcinoma, England, first tumours diagnosed 2014 to 2016, from the NDRS Get Data Out programme): https://www.cancerresearchuk.org/about-cancer/skin-cancer/survival
- van Bodegraven et al., British Journal of Dermatology 2023;188(6):777 to 784: 'Get Data Out' Skin, national cancer registry incidence and survival rates for all registered skin tumour groups for 2013 to 2019 in England: https://doi.org/10.1093/bjd/ljad033
- Mistry, Levell, Karponis, Wakkee, Whiteman, Proby and Venables, British Journal of Dermatology 2026: trends in keratinocyte cancers in England 2013 to 2022, basal cell carcinoma incidence, cutaneous squamous cell carcinoma incidence and non-melanoma skin cancer mortality: https://doi.org/10.1093/bjd/ljag315
- Kwiatkowska et al., Skin Health and Disease 2021;1(4):e61: an updated report on the incidence and epidemiological trends of keratinocyte cancers in the United Kingdom 2013 to 2018: https://doi.org/10.1002/ski2.61
- NHS: non-melanoma skin cancer, symptoms: https://www.nhs.uk/conditions/non-melanoma-skin-cancer/symptoms/

## Connected records

- cancers: [Advanced cutaneous squamous cell carcinoma](https://onco.cc/cancers/advanced-cutaneous-scc/), [Basal cell carcinoma](https://onco.cc/cancers/basal-cell-carcinoma/), [Bowen's disease (squamous cell carcinoma in situ)](https://onco.cc/cancers/bowens-disease/), [HPV-independent vulvar squamous cell carcinoma (p53-mutant)](https://onco.cc/cancers/hpv-independent-vulvar-cancer/), [Melanoma](https://onco.cc/cancers/melanoma/), [Merkel cell carcinoma](https://onco.cc/cancers/merkel-cell-carcinoma/), [Penile cancer](https://onco.cc/cancers/penile/), [Skin cancer (all types)](https://onco.cc/cancers/skin-cancer/)
- technologies: [Black salve and other escharotic pastes](https://onco.cc/technologies/black-salve-escharotics/), [Chemoprevention & risk-reducing surgery](https://onco.cc/technologies/chemoprevention/), [Dermoscopy, total-body photography & AI skin analysis](https://onco.cc/technologies/dermoscopy-ai/), [Electrochemotherapy](https://onco.cc/technologies/electrochemotherapy/), [Facial reconstruction and facial prostheses: ears, orbits and noses](https://onco.cc/technologies/rejuv-recon-facial-prosthetics/), [Immune checkpoint inhibitors](https://onco.cc/technologies/checkpoint-inhibitor/), [IMRT / IGRT (modern external beam)](https://onco.cc/technologies/imrt-igrt/), [Monoclonal antibodies](https://onco.cc/technologies/monoclonal-antibody/), [Multidisciplinary tumour boards](https://onco.cc/technologies/multidisciplinary-tumour-board/), [Oncolytic viruses](https://onco.cc/technologies/oncolytic-virus/), [Psycho-oncology and distress screening](https://onco.cc/technologies/psycho-oncology/), [Sentinel lymph node biopsy](https://onco.cc/technologies/sentinel-node/), [Skin cancer screening (visual skin examination)](https://onco.cc/technologies/skin-cancer-screening/), [Superficial and orthovoltage radiotherapy for skin cancer](https://onco.cc/technologies/superficial-radiotherapy/), [Survivorship care and late-effects surveillance](https://onco.cc/technologies/survivorship-care-plan/)
- targets: [ACVR2A](https://onco.cc/targets/acvr2a/), [ARHGEF10](https://onco.cc/targets/arhgef10/), [CNTRL](https://onco.cc/targets/cntrl/), [EGFR](https://onco.cc/targets/egfr/), [ELN](https://onco.cc/targets/eln/), [PD-1](https://onco.cc/targets/pd1/), [PD-L1](https://onco.cc/targets/pdl1/), [TP53](https://onco.cc/targets/tp53/)
- drugs: [Acitretin](https://onco.cc/drugs/acitretin/), [Aminolevulinic acid (topical, for photodynamic therapy)](https://onco.cc/drugs/aminolevulinic-acid/), [Carboplatin](https://onco.cc/drugs/carboplatin/), [Cemiplimab](https://onco.cc/drugs/cemiplimab/), [Cetuximab](https://onco.cc/drugs/cetuximab/), [Cosibelimab](https://onco.cc/drugs/cosibelimab/), [HMBD-001](https://onco.cc/drugs/hmbd-001/), [Imiquimod](https://onco.cc/drugs/imiquimod/), [Nicotinamide](https://onco.cc/drugs/nicotinamide/), [Pembrolizumab](https://onco.cc/drugs/pembrolizumab/), [Sirolimus](https://onco.cc/drugs/sirolimus/), [Vusolimogene oderparepvec](https://onco.cc/drugs/vusolimogene-oderparepvec/)
- companies: [Almirall](https://onco.cc/companies/almirall/), [Checkpoint Therapeutics](https://onco.cc/companies/checkpoint-therapeutics/), [Galderma](https://onco.cc/companies/galderma/), [LEO Pharma](https://onco.cc/companies/leo-pharma/), [Merck & Co. (MSD)](https://onco.cc/companies/merck/), [Rakuten Medical](https://onco.cc/companies/rakuten-medical/), [Regeneron](https://onco.cc/companies/regeneron/), [Replimune](https://onco.cc/companies/replimune/), [Sanofi](https://onco.cc/companies/sanofi/), [Summit Therapeutics](https://onco.cc/companies/summit-therapeutics/)
- pathways: [Field cancerisation](https://onco.cc/pathways/field-cancerisation/), [p53 / RB / cell-cycle checkpoint](https://onco.cc/pathways/p53-cell-cycle/), [PD-1 / PD-L1 immune checkpoint & T-cell activation](https://onco.cc/pathways/pd1-checkpoint/)
- terms: [Actinic keratosis (solar keratosis): sun damage, not cancer](https://onco.cc/terms/actinic-keratosis/), [Carcinoma in situ (CIS)](https://onco.cc/terms/carcinoma-in-situ/), [Curative intent vs palliative intent](https://onco.cc/terms/curative-intent/), [Curettage and cautery](https://onco.cc/terms/curettage-and-cautery/), [How skin carcinoma is staged in Britain: UICC TNM, and why it is not the American system](https://onco.cc/terms/tnm-skin-carcinoma/), [Immune-related adverse events (irAEs)](https://onco.cc/terms/irae/), [Inherited syndromes that cause skin cancer: Gorlin syndrome and xeroderma pigmentosum](https://onco.cc/terms/inherited-skin-cancer-syndromes/), [Keratinocyte cancer (and why 'non-melanoma skin cancer' is being retired)](https://onco.cc/terms/keratinocyte-cancer/), [Keratoacanthoma: the tumour that may be a squamous cell carcinoma](https://onco.cc/terms/keratoacanthoma/), [Mohs surgery](https://onco.cc/terms/mohs-surgery/), [Pathologic complete response (pCR)](https://onco.cc/terms/pcr/), [Perineural invasion (PNI)](https://onco.cc/terms/perineural-invasion/), [Radiotherapy for skin cancer](https://onco.cc/terms/radiotherapy-for-skin-cancer/), [Resection margins (R0 / R1 / R2)](https://onco.cc/terms/resection-margins/), [Skin cancer after an organ transplant](https://onco.cc/terms/skin-cancer-after-organ-transplant/), [Skin cancer after cancer treatment](https://onco.cc/terms/second-primary-skin-cancer-after-cancer-treatment/), [Skin grafts and flaps after skin cancer surgery](https://onco.cc/terms/skin-graft-and-flap-reconstruction/), [Sun protection after a skin cancer diagnosis](https://onco.cc/terms/sun-protection-after-skin-cancer/), [The Brigham and Women's Hospital staging system, and why squamous cell carcinoma has two](https://onco.cc/terms/bwh-staging-cscc/), [The margin in skin cancer surgery](https://onco.cc/terms/surgical-margins-keratinocyte-cancer/), [The next skin cancer: second primaries after a keratinocyte cancer](https://onco.cc/terms/second-primary-skin-cancer/), [The scar on the face after skin cancer surgery](https://onco.cc/terms/facial-scar-after-skin-cancer/), [The subtype and grade on a cutaneous squamous cell carcinoma report](https://onco.cc/terms/cscc-subtype-and-grade/), [Tumour mutational burden (TMB)](https://onco.cc/terms/tmb/), [What makes a skin cancer high risk: the UK feature lists](https://onco.cc/terms/skin-cancer-high-risk-features/), [Why nobody knows how many skin cancers there are: the counting rule behind every figure](https://onco.cc/terms/keratinocyte-cancer-counting/), [Wide local excision](https://onco.cc/terms/wide-local-excision/)
- trials: [A Phase Ib/II Study of an Anti-HER3 Antibody, HMBD-001, With Cetuximab +/- Docetaxel in Advanced Squamous Cell Cancers](https://onco.cc/trials/nct05910827/), [A Study of IDP-001 in Advanced or Metastatic Solid Tumors](https://onco.cc/trials/nct07602842/), [An Open-label Study Using ASP-1929 Photoimmunotherapy in Combination With Anti-PD1 Therapy in EGFR Expressing Advanced Solid Tumors](https://onco.cc/trials/nct04305795/), [C-POST (cemiplimab after surgery and radiotherapy for high-risk skin squamous cell carcinoma)](https://onco.cc/trials/c-post/), [Cemiplimab for kidney transplant recipients with advanced skin squamous cell carcinoma](https://onco.cc/trials/cemiplimab-kidney-transplant-cscc/), [CK-301-101](https://onco.cc/trials/ck-301-101/), [EMPOWER-CSCC-1](https://onco.cc/trials/empower-cscc-1/), [Flash Radiotherapy for Skin Cancer](https://onco.cc/trials/nct07455331/), [KEYNOTE-629](https://onco.cc/trials/keynote-629/), [Mohs surgery against ordinary excision for facial basal cell carcinoma (Maastricht trial)](https://onco.cc/trials/mohs-versus-excision-facial-bcc/), [Neoadjuvant cemiplimab for resectable stage II to IV skin squamous cell carcinoma](https://onco.cc/trials/neoadjuvant-cemiplimab-cscc/), [SCC-AFTER](https://onco.cc/trials/scc-after/), [SPOT-IT](https://onco.cc/trials/spot-it/), [Study Evaluating Cemiplimab Alone and Combined With RP1 in Treating Advanced Squamous Skin Cancer](https://onco.cc/trials/nct04050436/), [Study of Intralesional Cemiplimab in Adult Patients With Early Stage Cutaneous Squamous Cell Carcinoma](https://onco.cc/trials/nct06585410/), [Study of the Monoclonal Antibody IMT-009 in Patients With Advanced Solid Tumors or Lymphomas](https://onco.cc/trials/nct05565417/), [Study to Investigate the Efficacy and Safety of RP1 in Adult Patients With Organ Transplants and Advanced Skin Malignancies](https://onco.cc/trials/nct04349436/), [TROG 05.01 (chemotherapy added to radiotherapy after surgery for high-risk skin squamous cell carcinoma)](https://onco.cc/trials/trog-05-01/), [TUMORAPA (switching from a calcineurin inhibitor to sirolimus after a transplant skin cancer)](https://onco.cc/trials/tumorapa/)
- institutions: [British Association of Dermatologists](https://onco.cc/institutions/british-association-of-dermatologists/), [Guy's and St Thomas' NHS Foundation Trust / King's Health Partners Cancer Centre](https://onco.cc/institutions/guys-st-thomas/), [Skcin (the Karen Clifford Skin Cancer Charity)](https://onco.cc/institutions/skcin/), [University of Arizona Cancer Center](https://onco.cc/institutions/arizona-cancer-center/), [Velindre Cancer Centre](https://onco.cc/institutions/velindre-cardiff/)
- people: [Dirk Schadendorf](https://onco.cc/people/dirk-schadendorf/), [Nick Levell](https://onco.cc/people/nick-levell/)
- key papers: [Efficacy and safety of cosibelimab, an anti-PD-L1 antibody, in metastatic cutaneous squamous cell carcinoma](https://onco.cc/key-papers/paper-ck-301-101-jitc-2023/), [Esteva 2017: a deep neural network classifies skin cancer at dermatologist level](https://onco.cc/key-papers/paper-esteva-skin-cancer-deep-learning-nature-2017/)

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JSON: https://onco.cc/api/v1/entities/cutaneous-scc.json