In a patient with high-risk cutaneous squamous cell carcinoma of the face with extracapsular extension after ipsilateral neck dissection and rapid contralateral cervical nodal recurrence, what is the optimal management?

In our series of unresectable cutaneous cell carcinoma (about 125 cases), we have an almost 50% complete clinical remission with cemiplimab. This is now the treatment of choice for such patients. For those who do not respond and cannot be resected with salvage surgery, the best option is probably ip...

I would suggest going with cemiplimab right now. If there is a response after 4 cycles, then a surgery can be attempted (albeit at a lesser scale) to determine the pathologic response. If the patient has achieved pCR, then further cemiplimab can be withheld (as per the NRG protocol, which is still u...