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

Badri Modi, MD
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
Baltimore, MD

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

Samantha Gordon, MS
Accreditation Manager 
Baltimore, MD

Amy Sison
Director of CME
Baltimore, MD 

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.

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Provided by Med-IQ.

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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.

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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

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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.
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Acknowledgment of Commercial Support
This activity is supported by educational grants from Regeneron Pharmaceuticals, Inc. and Sanofi Genzyme.
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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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