RECOMMENDATION 1: DEFINITION OF ADVANCED cSCC

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* 1. Question 1A: Locally advanced cSCC represents a subset of local tumors in which curative-intent treatment with surgery or radiation is unlikely because the disease...

  1 - Strongly Disagree 2 - Moderately Disagree 3 - Disagree 4 - Mildly Disagree 5 - Neutral 6 - Mildly Agree 7 - Agree 8 - Moderately Agree 9 0 Strongly Agree
1A-1: demonstrates substantial local invasion precluding complete surgical resection.
1A-2: involves an anatomic location in which surgery and/or radiation would result in severe disfigurement or dysfunction.
1A-3: is recurrent following 2 or more prior surgical resections by a surgeon experienced in treating cutaneous cancer and for which further curative resection is deemed unlikely to clear margins and obtain long term cure/disease control.
1A-4: is judged unlikely to respond to radiotherapy by a radiation oncologist experienced in treating cutaneous cancers.
1A-5: arises in a previously irradiated site where re-irradiation would exceed cumulative dose threshold as determined by a radiation oncologist experienced in treating cutaneous cancers.
1A-6: includes in transit metastasis between the primary cSCC and anticipated surrounding draining lymph nodes.

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* 2. Question 1B: Advanced metastatic cSCC represents:

  1 - Strongly Disagree 2 - Moderately Disagree 3 - Disagree 4 - Mildly Disagree 5 - Neutral 6 - Mildly Agree 7 - Agree 8 - Moderately Agree 9 - Strongly Agree
1B-1: regional disease unlikely to be controlled with curative-intent surgery with or without adjuvant radiation.
1B-2: distant metastatic disease unlikely to be controlled with curative-intent surgery with or without adjuvant radiation. 
1B-3: biopsy proven cSCC in the subcutaneous tissues beyond the draining lymphatics of the primary location (i.e. dermal metastasis).

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* 3. Question 1C: Advanced cSCC comprises both locally advanced and metastatic cSCC in which curative intent surgery and/or radiation is unlikely to achieve meaningful disease free control.

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* 4. Question 1D: Patients must be evaluated by a surgeon and a radiation oncologist experienced in treating cSCC prior to being identified as a patient with advanced cSCC.

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* 5. Question 1E: Medical record documentation citing the specific reason(s) a patient failed candidacy for surgery and radiation should be provided by the respective specialists prior to considering PD-1 inhibitor treatment.

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