Metastatic Cutaneous Squamous Cell Carcinoma - Episode 3
Gregory A. Daniels, MD:The question of when to refer to other providers is a difficult one. A dermatologist is usually presented with a lesion, and I think the thought process should be again along the lines of, is this a low-risk patient or a high-risk patient? For low risk, simple excision makes sense, and just confirming that one has negative borders, whether that’s with the Mohs technique, or some other margin assessment technique.
However, when you get to a lesion where it might need reconstruction and/or the chance that the recurrence is, as I mentioned earlier, more than 10%, that’s a time where referral should happen. That would be to ENT [ears, nose, and throat] surgery, for example, in the head and neck area. That’s what we commonly use, or plastic surgery. In those cases, once the referral is made, I think a team approach with a radiation therapist and even a medical oncologist comes in to play.
When there’s a question of resectability for a lesion, I think that’s a red flag for referral to consider all the alternatives. The options include resection. However, we need to balance the morbidities of that resection and patient preference, as well as what the patient can tolerate and what their goals are. One may also consider systemic therapies in the case of these questionably resectable lesions, or when they’re clearly not resectable. There are some newer agents that have activity in unresectable squamous cell cancer that means that we need to have this discussion anew.
Transcript edited for clarity.
Case: A 79-Year-Old Male With Metastatic CSCC