Clinical Toolkit

Cutaneous squamous cell carcinoma (cSCC) is the second most common form of skin cancer, and it occurs most frequently in sun-exposed regions of the skin. In immunosuppressed populations it is a source of considerable morbidity and mortality due to its increased recurrence and potential for metastasis.

cSCC is estimated to have a lifetime incidence of 7%-11% in the USA. Patients with cSCC may develop multiple lesions, and although this cancer is usually cured by surgical excision, approximately 8% of patients with cSCC develop a recurrence and 5% present with metastasis within 5 years. Additionally, surgical resection can often be extensive and disfiguring, especially around cosmetically sensitive areas. In patients with metastatic cSCC, the prognosis is very poor, with a 70% mortality rate. The majority of deaths (70%) are due to unresectable locoregional disease rather than distant metastases. This highlights the importance of identifying high-risk patients early for resection to minimize the risk of recurrence, progression to unresectability, or death.

Data suggest a strong link between non-melanoma skin cancer (NMSC) and the immune system. Immunosuppression is widely recognized as a risk factor for the development of NMSC, and the increasing use of therapeutic immunosuppression is most likely contributing to the increasing incidence of NMSC. Additional evidence suggests that NMSCs sometimes regress after improvement in immune function, further underscoring the importance of immune surveillance in their pathogenesis.