Cutaneous squamous cell carcinoma (CSCC) is a type of cancer that starts in the squamous cells of the skin and is usually treatable with surgery or other less invasive therapies.
But if the cancer cells metastasize (spread) to the lymph nodes or other areas of the body, the treatment protocols are more complex.
The care options your doctor recommends will depend on how extensive your cancer is, your overall health, and other factors.
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How Serious Is Metastatic CSCC?
CSCC that’s detected early can usually be effectively treated. According to the Skin Cancer Foundation, about 95 percent of CSCCs are caught early enough that they’re curable.
When CSCC is more advanced and has traveled to other areas in the body, the outcome generally isn’t as positive. Less than one-half of individuals who have a CSCC that metastasizes beyond the skin live five years, notes Harvard Health.
Up to 15,000 people in the United States die from advanced CSCC each year.
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Care Guidelines for Metastatic CSCC
Because it’s relatively unusual for CSCC to metastasize, the treatment guidelines aren’t as clear-cut as they are for other forms of cancer.
When CSCC spreads only to areas close to the cancer (such as nearby tissues or lymph nodes), it’s known as “locally advanced” disease. When it travels to more distant parts of the body, it’s typically referred to as metastatic CSCC.
In a paper published in the Journal of the American Academy of Dermatology in January 2018, researchers recommended the following guidelines for locally advanced or metastatic CSCC:
- If the cancer has spread to regional lymph nodes, surgery with or without radiation and possibly systemic treatment (such as chemotherapy, targeted therapy, or immunotherapy) is recommended. If the cancer is inoperable, a combination of chemotherapy and radiation is recommended.
- Treatment with an epidermal growth factor inhibitor and cisplatin (a chemotherapy agent) alone or in combination may be considered.
- Patients are encouraged to seek a multidisciplinary consultation with their medical team, especially if they are immunocompromised.
- Patients with advanced disease should be provided with information on palliative care services to help maximize their quality of life.
In September 2018, the U.S. Food and Drug Administration (FDA) approved the immunotherapy medicine Libtayo (cemiplimab-rwlc) for certain patients with metastatic or locally advanced CSCC. The drug works by blocking a checkpoint called PD-1. This process helps your immune system attack tumor cells better.
The National Comprehensive Cancer Network (NCCN) recommends that patients with CSCC that has spread and can’t have surgery should consider treatment with Libtayo.
In a clinical study, about one-half of patients with advanced CSCC who took Libtayo saw their tumors shrink.
Keytruda (Pembrolizumab) is another immunotherapy that has been approved by the FDA for treating advanced CSCC.
Because there isn’t a lot of research on the most optimal way to treat metastatic CSCC, the NCCN recommends that patients with advanced disease consider joining a clinical trial. Participating in a research study may give you the opportunity to try a new therapy that isn’t yet available to the general public.
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Follow-Up Guidelines for Metastatic CSCC
After treatment, you may be concerned about having another skin cancer.
The NCCN stresses the importance of monitoring for new CSCCs during the first two years after treatment.
NCCN experts recommend that you:
- Perform skin self-exams
- Undergo regular skin exams with your dermatologist
- Be diligent about prevention measures, such as sun protection
Some people who are at high-risk for CSCC may benefit from medicines or topical treatments that help prevent skin cancers from forming. Talk to your doctor about how to proceed after your treatment.
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Sun Protection: How to Avoid CSCC
Practicing good sun safety is the most important way to prevent CSCC.
The Centers for Disease Control and Prevention (CDC) recommends the following actions:
- Wear Sun Protective Gear Long-sleeved shirts, clothing with ultraviolet protection, sunglasses, and hats can safeguard you from the sun’s harmful rays.
- Slather on Sunscreen Use a broad-spectrum sunscreen with a sun protection factor (SPF) of 15 or higher and reapply it every two hours.
- Seek Shade Finding shade under an umbrella, tree, or other shelter can reduce your risk of skin damage and skin cancer.
- Avoid the Sun During Peak Hours Try to steer clear of the sun from 10 a.m. to 4 p.m.
- Avoid Tanning Devices Tanning beds can increase your risk for skin cancer.
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Metastatic CSCC: The Bottom Line
Because metastatic CSCC is rare, the care practices and guidelines aren’t as well-defined as they are with other forms of cancer.
But if your cancer spreads, there are options for you and your doctor to consider.
Don’t be hesitant to ask your physician about all of your choices. The NCCN also recommends comparing the pros and cons of each treatment and getting a second opinion.