Pipeline and open problemsCutaneous squamous cell carcinoma

2 medicines on record are linked to one of the types below rather than to Cutaneous squamous cell carcinoma itself. Grouped by the type that holds them; each list opens that type's own page.

• 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.

  What is being done about this

  Cost and access

  and how the field plans to fix it →

  Available now

  • Immune checkpoint inhibitorsStandard of care
  • SirolimusApproved

  In trials

  • Neoadjuvant cemiplimab for resectable stage II to IV skin squamous cell carcinomaPositive

  Ideas and roadmaps

  Nothing recorded yet.

  Also on OnCo: Financial help · Coverage by country · Funding verdicts by country.

• 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.

  What is being done about this

  Advanced and metastatic disease

  and how the field plans to fix it →

  Available now

  • ElectrochemotherapyEstablished
  • IMRT / IGRT (modern external beam)Standard of care
  • Sentinel lymph node biopsyStandard of care

  In trials

  • A Study of IDP-001 in Advanced or Metastatic Solid TumorsRecruiting
  • KEYNOTE-629Positive

  Ideas and roadmaps

  Nothing recorded yet.

  Also on OnCo: Atlas of advanced disease · How cancer spreads: the metastasis stages.