This video is sponsored by Sun Pharma. Its content is editorially independent of the sponsor.
In this episode of Topical Conversations, Vishal Patel, MD, and David Miller, MD, PhD, examine how the management of cutaneous squamous cell carcinoma (cSCC) has shifted from a specialty-specific approach to a truly multidisciplinary model. Their discussion centers on how dermatologists partner with surgeons, radiation oncologists, and medical oncologists to manage increasing disease complexity, while remaining actively involved from diagnosis through long-term surveillance.
cSCC as a team-based disease
cSCC is no longer solely a dermatologic or surgical problem. While many tumors remain straightforward to manage, more advanced cases increasingly require coordination across multiple specialties. Drs Patel and Miller emphasize that optimal outcomes, particularly in high-risk or advanced disease, depend on early collaboration and thoughtful sequencing of surgery, radiation, and systemic therapy.
A wide and heterogeneous clinical spectrum
They reinforce the broad clinical range of cSCC, spanning low-risk tumors to locally advanced disease, perineural invasion, recurrent tumors, nodal involvement, and metastatic spread. Dermatologists are often the point of entry, responsible for diagnosis, initial risk stratification, and determining when escalation is needed. However, Dr Miller notes that no single specialty holds all the answers and that successful management hinges on assembling the right combination of modalities for each patient.
Recognizing complexity and when to expand the team
A central challenge for dermatologists is identifying when a case is becoming more complex. Dr Patel outlines red flags that should prompt earlier multidisciplinary engagement, including rapid tumor growth, recurrence, deep invasion, perineural symptoms, and tumors in anatomically challenging locations. Dr Miller adds immunosuppression, multiple recurrences, and nodal disease as signals that early collaboration may meaningfully alter the treatment trajectory.
Both stress the importance of not waiting until options are limited. Early input from surgery, radiation oncology, and medical oncology allows for better planning around margins, adjuvant therapy, and systemic treatment considerations.
The dermatologist’s role beyond referral
The conversation challenges the notion that dermatologists step back once oncology becomes involved. Dr Patel highlights the dermatologist’s ongoing role in managing field cancerization, monitoring for secondary primaries, and providing long-term surveillance. Dr Miller adds that patients often place deep trust in their dermatologists, positioning them to reinforce education, address concerns, and help manage skin-related adverse events even when another specialist is leading systemic therapy.
Multidisciplinary decision-making in real-world practice
While formal tumor boards are ideal, Dr Patel acknowledges that they are not always feasible. Dr Miller describes practical alternatives, such as informal case discussions via email, phone calls, or brief in-person conversations to align on sequencing, goals of care, and follow-up responsibilities. Both note that time constraints and fragmented care can be mitigated by cultivating a reliable network of colleagues and maintaining proactive communication.
Where systemic therapy fits
Systemic therapy has become an integral part of modern cSCC management rather than a last-line option. Dr Miller reiterates that timing and sequencing are critical, whether systemic therapy is used before surgery, after radiation, or as a standalone approach. Patel adds that even when dermatologists are not prescribing these agents, understanding when they are appropriate helps guide referrals and set realistic patient expectations.
Cosibelimab in the multidisciplinary framework
The discussion turns to PD-1 inhibition, now well established in advanced cSCC. Dr Patel notes that response and tolerability vary, particularly in older patients with comorbidities. Dr Miller points to emerging data suggesting cosibelimab, a PD-L1 inhibitor, may offer a favorable tolerability and safety profile, an important consideration in real-world populations.
They emphasize that familiarity with where cosibelimab may fit, whether alongside surgery or radiation, or in unresectable or metastatic disease, allows dermatologists to better guide referrals, support shared decision-making, and manage skin-related adverse events. Even when medical oncologists lead systemic therapy, ongoing dermatologic involvement remains essential as the PD-1 and PD-L1 inhibitor landscapes continues to mature.
Communication, coordination, and the patient experience
From the patient’s perspective, multidisciplinary care can feel either reassuring or overwhelming. Dr Miller stresses that clear handoffs, consistent messaging, and defined follow-up plans are critical to maintaining trust, particularly in advanced disease, where treatment plans may evolve over time.
Common pitfalls and practice pearls
Dr Patel cautions that dermatologists may underestimate how quickly cSCC can progress once advanced and how impactful early multidisciplinary input can be. Common pitfalls include delayed referrals, unclear ownership of follow-up, and assumptions that another provider is monitoring the patient.
Both physicians highlight simple but effective strategies: clear documentation, direct communication with key colleagues, and staying engaged even after referral. These steps can significantly improve care coordination and outcomes.
Key takeaways