Advanced cutaneous squamous cell carcinoma (CSCC) is cancer that starts in your skin and spreads. It may be a very fast-moving cancer that spreads before you’re diagnosed. Or, it could have returned after you were treated.
Locally advanced CSCC has spread into the tissues, muscles, or nerves below the skin. Metastatic CSCC means the cancer has spread to other parts of your body.
Once your cancer spreads, it’s a more serious threat to your health, but it’s still treatable.
It can feel overwhelming to learn you have a late-stage cancer. Your doctor and other members of your treatment team will help you understand your cancer, and the best ways to treat it. Here’s a guide to help you start a conversation with your doctor.
To treat advanced CSCC, you may need to see a whole team of doctors, including a(n):
- oncologist — a cancer specialist
- dermatologist — a doctor who treats skin diseases
If the cancer hasn’t spread much beyond your skin, it may be treatable with surgery alone. Skin cancer that has spread to other organs will require body-wide treatments like radiation and immunotherapy.
Two types of surgery remove CSCC:
Excisional surgery cuts out the whole tumor using a scalpel. The surgeon also removes a margin of healthy tissue around the tumor. The removed tissue goes to a lab, which tests it. If there is still cancer in the outer margins of the skin, you may need more surgery.
During excisional surgery, your surgeon may also remove any lymph nodes where the cancer has spread.
Mohs surgery removes the cancer one layer at a time. The surgeon checks each layer under a microscope while you wait. The process is repeated until no cancer cells remain.
When the cancer is advanced, surgery alone may not be enough to treat it. Your doctor might recommend other treatments to kill cancer cells in other parts of your body.
Radiation therapy uses powerful X-rays to destroy cancer. You may have radiation if your tumor is in a place where it’s not easy to remove with surgery, or if you’re not healthy enough for surgery.
Radiation also helps to relieve cancer symptoms. This type of treatment is called palliative therapy. It can make you feel more comfortable.
You may also get radiation before surgery to shrink the tumor and make it easier to remove, or after surgery to kill any cancer cells that were left behind. Radiation can also help immunotherapy work more effectively.
Doctors deliver radiation in a couple of ways. External beam radiation therapy aims rays at the tumor from a machine outside your body. Brachytherapy places radioactive implants inside your body, near the tumor.
Sometimes chemotherapy drugs are added to radiation to kill more cancer cells. This combination is called chemoradiation. You may get it after surgery.
In 2018, the FDA approved the first treatment specifically for advanced CSCC. Cemiplimab-rwlc (Libtayo) is a type of immunotherapy drug called a checkpoint inhibitor.
Checkpoints are substances that prevent your immune system from attacking your body’s own healthy cells. Cancer cells sometimes use checkpoints to “hide” from the immune system and keep growing.
Libtayo is a checkpoint inhibitor that stops a checkpoint called PD-1 from working. This releases the brakes on your immune system so it can attack the cancer.
Libtayo treats CSCC that has spread. It’s also an option for people who aren’t candidates for surgery or radiation therapy.
This treatment is given at a hospital or cancer treatment center once every 3 weeks. It comes as an infusion that you get through a vein (IV). The treatment takes about 30 minutes.
Surgery can cause risks like bleeding, infection, and scarring. If the surgeon needs to remove a large area of skin, a graft taken from another part of your body may be used to cover the wound.
Radiation kills healthy cells along with the cancer. The type of side effects depends on where on your body you got the radiation, but they can include:
- dryness, itching, redness, and peeling at the treatment site
- nausea and vomiting
- hair loss
The most common side effects from Libtayo are tiredness, rash, and diarrhea. Rarely, this drug can cause more serious immune system reactions.
Researchers are investigating another type of immunotherapy called pembrolizumab (Keytruda) to see if it works on advanced CSCC. One study under way is trying to see if this treatment can improve survival or cure the disease in people who’ve already had surgery and radiation therapy.
A type of targeted therapy called epidermal growth factor receptor (EGFR) inhibitors may also be used to treat this cancer. Examples include cetuximab (Erbitux) and erlotinib (Tarceva).
Keytruda and other new treatments are being studied in clinical trials. Joining one of these studies could give you access to a new and possibly better treatment than what’s currently available. Ask the doctor who treats your cancer if a clinical trial is right for you.
Once you’ve had CSCC, you’re at higher risk for another skin cancer, such as another squamous cell carcinoma (SCC) or a different type of skin cancer like melanoma or basal cell carcinoma.
Regular screening will ensure that you catch any new cancer early, when it’s easiest to treat. Ask your dermatologist how often you should have skin checks.
Also, protect yourself when you’re in the sun. Apply a broad-spectrum sunscreen with UVA and UVB protection whenever you go outdoors. Wear a broad-brimmed hat and try to stay in the shade as much as possible.
The main treatment for advanced CSCC is surgery to remove the cancer and some of the healthy tissue around it. If your cancer has spread to other parts of your body or you can’t have surgery, other options include radiation, chemotherapy, and immunotherapy.
The first drug specifically for this type of cancer was FDA-approved in 2018. Other new treatments are under investigation. With each new therapy, advanced CSCC becomes easier to treat, and the outlook improves even more for people with this cancer.