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Recent Advances in the Assessment, Risk Stratification, and Treatment of Advanced CSCC: Effect on Care Coordination in Dermatology Practice

Recent Advances in the Assessment, Risk Stratification, and Treatment of Advanced CSCC: Effect on Care Coordination in Dermatology Practice

Med-IQ Select
Online Course | Specialties: Dermatology
Released: 1/29/2021
|
Expires: 1/28/2022
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Max Credits: 0.75
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Faculty
Lara Dunn, MD
Medical Oncologist
Memorial Sloan Kettering Cancer Center
New York, NY

Badri Modi, MD
Dermatologist
Assistant Clinical Professor, Division of Dermatology
Department of Surgery
City of Hope Comprehensive Cancer Center
Duarte, CA

Activity Planners
Christie Avraamides, PhD
Clinical Content Manager
Med-IQ
Baltimore, MD

Rebecca L. Julian, MS, ELS
Senior Manager, Editorial
Med-IQ
Baltimore, MD

Samantha Gordon, MS
Accreditation Manager 
Med-IQ
Baltimore, MD

Amy Sison
Director of CME
Med-IQ
Baltimore, MD 

Writer
Edward Allan Racela Sison, MD
Missouri City, TX
  
Learning Objectives
Upon completion, participants should be able to:

  • Describe the pathophysiology and molecular biology of CSCC, as well as changes that occur during its progression
  • Delineate patient risk levels based on recent guidance, updated staging systems, and clinical and pathologic features
  • Identify and appropriately refer candidates with advanced CSCC who may benefit from new and emerging immunotherapies 

Target Audience
This activity is intended for dermatologists. 
 
Statement of Need
In the United States (US), an estimated 1 million individuals are affected by CSCC each year. Although locoregional or distant metastatic disease occurs in only 1% to 5% of cases, mortality in these individuals is high. Several clinical and pathologic features correlate with an increased risk of tumor recurrence and metastasis; however, there is a lack of agreement over the definition of high-risk CSCC. Therefore, a greater understanding of the CSCC features associated with poor prognosis is needed among dermatologists. In terms of treatment, surgical management is the most effective for CSCC, and the majority of CSCC cases are amenable to surgery alone. However, 10% of cases progress to advanced CSCC.  Recently, 2 immunotherapies were approved by the US Food and Drug Administration for advanced CSCC, which has practice-changing implications across the clinical disciplines that diagnose, assess, and treat patients with advanced/malignant CSCC. Dermatologists must be able to identify appropriate patients for excision in a dermatology office, referral for surgical evaluation, and referral to a medical oncologist for evaluation for systemic therapy.

Providership Statement
Provided by Med-IQ.

Accreditation/Designation Statements
Med-IQ is accredited by the Accreditation Council for Continuing Medical Education (ACCME) to provide continuing medical education for physicians.  

Med-IQ designates this enduring material for a maximum of 0.75 AMA PRA Category 1 Credit™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
 
CME MOCSuccessful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to 0.75 MOC points from the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program. Participants will earn MOC points equivalent to the amount of CME credits claimed for the activity. It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting ABIM MOC credit.

CLAIMING MOC POINTS: If you intend to claim MOC points for your participation, you will need to provide your unique, six-digit ABIM ID Number. Please note, your name, ABIM ID number, birthdate and completion status will be shared with ABIM through the ACCME PARS system. Your points will be automatically submitted to the ABIM on your behalf; please allow 4 weeks for your points to display on the ABIM website.

Medium/Method of Participation
This is a 0.75-credit CME activity. To receive credit, read the introductory CME material, complete all of the modules, and complete the evaluation, attestation, and post-test, answering at least 70% of the post-test questions correctly.

Initial Release Date: 1/29/2021
Expiration Date: 1/28/2022
Estimated Time to Complete This Activity: 45 minutes

Disclosure Policy
Med-IQ requires any person in a position to control the content of an educational activity to disclose all relevant financial relationships with any commercial interest. The ACCME defines “relevant financial relationships” as those in any amount occurring within the past 12 months, including those of a spouse/life partner, that could create a conflict of interest (COI). Individuals who refuse to disclose will not be permitted to contribute to this CME activity in any way. Med-IQ has policies in place that will identify and resolve COIs prior to this educational activity. Med-IQ also requires faculty to disclose discussions of investigational products or unlabeled/unapproved uses of drugs or devices regulated by the US Food and Drug Administration.

Drug/Product Usage by Faculty
Off-label/unapproved drug uses or products are mentioned within this activity. 

Disclosure Statement
The content of this activity has been peer reviewed and has been approved for compliance. The faculty and contributors have indicated the following financial relationships, which have been resolved through an established COI resolution process, and have stated that these reported relationships will not have any impact on their ability to give an unbiased presentation.

Lara Dunn, MD
Consulting fees/advisory boards: Merck & Co., Inc., Regeneron Pharmaceuticals, Inc.
Contracted research: Cue Biopharma, Eisai Inc., Regeneron Pharmaceuticals, Inc.

Badri Modi, MD
Consulting fees/advisory boards: Regeneron Pharmaceuticals, Inc., Sanofi Genzyme 
Fees received for promotional/non-CME activities: Regeneron Pharmaceuticals, Inc., Sanofi Genzyme 

Edward Allan Racela Sison, MD
Salary: Covance, Inc., LabCorp, Precision Medical Group 
Ownership interest (stocks/stock options – excluding mutual funds): LabCorp, Precision Medical Group, United HealthCare 
 
The peer reviewers and other activity planners have no financial relationships to disclose.
 
Statement of Evidence-Based Content
Educational activities that assist physicians in carrying out their professional responsibilities more effectively and efficiently are consistent with the ACCME definition of continuing medical education (CME). As an ACCME-accredited provider of CME, Med-IQ has a policy to review and ensure that all the content and any recommendations, treatments, and manners of practicing medicine in CME activities are scientifically based, valid, and relevant to the practice of medicine. Med-IQ is responsible for validating the content of the CME activities it provides. Specifically, (1) all recommendations addressing the medical care of patients must be based on evidence that is scientifically sound and recognized as such within the profession; (2) all scientific research referred to, reported, or used in CME in support or justification of a patient care recommendation must conform to generally accepted standards of experimental design, data collection, and analysis.

Med-IQ is not liable for any decision made or action taken in reliance upon the information provided through this activity. 
 
Contact Information
For questions or comments about this activity, please contact Med-IQ. Call (toll-free) 866 858 7434 or email info@med-iq.com.

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Disclaimer
The information provided through this activity is for continuing education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient’s medical condition.

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Med-IQ is committed to honoring your privacy and protecting any personal information you choose to share with us. For detailed information about our privacy notice, please visit: www.med-iq.com/privacy-statement/.

Acknowledgment of Commercial Support
This activity is supported by educational grants from Regeneron Pharmaceuticals, Inc. and Sanofi Genzyme.
 
Copyright
© 2021 Med-IQ, Inc.

Abstract

Here are the key takeaways from this activity. Deeper insights and evidence, plus an opportunity to receive credit, are available at the "Continue" button below.

  • CSCC has one of the highest mutational burdens of all cancers; this high mutational burden suggests that immunotherapy may be a useful treatment strategy
  • An analysis of published studies of 27 tumor types or subtypes demonstrated a significant correlation between tumor mutational burden and response to anti–PD-1/PD-L1 therapy
  • Cancer staging systems in CSCC aim to stratify patients into defined risk groups to predict clinical outcome and guide the selection of optimal treatment plans
  • Clinical features that suggest a lesion has a high risk of aggressive tumor behavior include anatomic location, tumor diameter, neurologic symptoms, recurrent tumor, and location within site of chronic wound, scar, or ionizing radiation
  • Patients with advanced CSCC should be managed by a multidisciplinary team
  • For patients who are candidates for surgery, options include C&E, wide local excision, or Mohs surgery
  • For patients with locally advanced, regional, or metastatic disease who are not surgical candidates, guidelines recommend curative radiation therapy
  • If radiation therapy is not feasible, systemic therapy may be used instead
  • For patients with regional disease for whom radiation therapy is not feasible or regional recurrence or patients with distant metastatic disease for whom curative surgery and curative radiation therapy are not feasible, immunotherapy with cemiplimab or pembrolizumb has emerged as first-line therapy

View reference list.

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Unless otherwise indicated, photographed subjects who appear within the content of this activity or on artwork associated with this activity are models; they are not actual patients or doctors.