European interdisciplinary guideline on invasive squamous cell carcinoma of the skin: Part 2. Treatment

Alexander J. Stratigos*, Claus Garbe, Clio Dessinioti, Celeste Lebbe, Veronique Bataille, Lars Bastholt, Brigitte Dreno, Maria Concetta Fargnoli, Ana M. Forsea, Cecille Frenard, Catherine A. Harwood, Axel Hauschild, Christoph Hoeller, Lidija Kandolf-Sekulovic, Roland Kaufmann, Nicole W. J. Kelleners-Smeets, Josep Malvehy, Veronique del Marmol, Mark R. Middleton, David Moreno-RamirezGiovanni Pellecani, Ketty Peris, Philippe Saiag, Marieke H. J. van den Beuken-van Everdingen, Ricardo Vieira, Iris Zalaudek, Alexander M. M. Eggermont, Jean-Jacques Grob, European Dermatology Forum (EDF), European Association of Dermato-Oncology (EADO), European Organization for Research and Treatment of Cancer (EORTC)

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

79 Citations (Web of Science)

Abstract

In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for nonsurgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics. (C) 2020 Elsevier Ltd. All rights reserved.

Original languageEnglish
Pages (from-to)83-102
Number of pages20
JournalEuropean Journal of Cancer
Volume128
DOIs
Publication statusPublished - Mar 2020

Keywords

  • Cutaneous squamous cell carcinoma
  • Locally advanced
  • Metastatic
  • Treatment
  • Surgical excision
  • Radiotherapy
  • Anti-PD-1 antibody
  • Cemiplimab
  • Chemotherapy
  • EGFR inhibitors
  • Follow-up
  • ORGAN TRANSPLANT RECIPIENTS
  • METASTATIC CUTANEOUS HEAD
  • ELECTIVE NECK DISSECTION
  • GROWTH-FACTOR RECEPTOR
  • IN-TRANSIT METASTASIS
  • CERVICAL LYMPH-NODES
  • PHASE-II
  • ADJUVANT RADIOTHERAPY
  • INTERFERON-ALPHA
  • INTRALESIONAL METHOTREXATE

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