AAD Conference Preview: Cutaneous Squamous Cell Carcinoma Updates

In this feature interview with The Dermatologist, Dr Lilia Correa previewed her session, “Cutaneous Squamous Cell Carcinoma Update,” before its presentation at the 2023 AAD Annual Meeting.

Lilia M Correa, MD, FAAD, is an assistant professor at the dermatology department of the University of South Florida and she is also a member of the interdisciplinary cutaneous oncology team at Moffitt Cancer Center in Tampa, FL.

Can you give us a preview of the key points your session will cover?

My session is essentially going to be an update on the current definitions of cutaneous squamous cell carcinoma and all the pathophysiology, which will include not only the tumor, but also the environment that takes this cancer from its inception and development. It will also include all the diagnosis techniques that we use, going from imaging techniques to staging 6 stems, such as how do they compare to each other? Also, I'm going to include some genetic profiling and the numbers that make this a very attractive diagnostic technique. I'm going to include all the current standards of care and establishing new and upcoming research, which will help treat our high-risk and most difficult-to-treat patients. Then, finally, I'm going to touch on prevention and all the strategies that we can use in our patients to help them develop less of this cancer or prevent the cancer for our high-risk patients.

How can the latest molecular, histopathological, and imaging studies aid in the diagnosis of cutaneous squamous cell carcinoma?

On the molecular level, currently there are a lot of very exciting things happening. We already have a genetic expression profile test that is commercially available, which gives us and our patients very important prognostic numbers, but in a few years, we're also going to be able to target our treatment depending on the genetic profile of squamous cell carcinoma and its various types. This is going to make the treatment not only very targeted, but much more effective because it's going to be more direct and personalized to that specific squamous cell.

As far as histopathology, currently it's our gold standard, because we not only use it to know and diagnose the type of skin cancer, but it's one of our most important parameters to locate the stages on our staging system as it uses a cytopathology to base where the tumor is. Of course, that will dictate treatment and prognosis of the patient.

For imaging, that’s probably my favorite part because we have 2 areas there. We have the diagnosis that we can use different techniques of imaging for, and then we have the follow up that we also use these different techniques for. As far as the diagnosis and follow up, we have techniques such as the thermoscope, reflectance, confocal microscopy, optic coherence tomography, and high frequency ultrasound. All these techniques help us elucidate a lot of diagnostic dilemmas and they help us follow patients that we're not necessarily treating with surgery, but who have other modalities. As far as our follow up of our high-risk patients, there are very important modalities such as CT and MRI, which we can use to see how we make these patients much less prone to develop a metastasis, or treating the metastasis as soon as we can.

For example, CT is the most commonly used modality for follow up, and there is research which shows that imaging high-risk patients will change treatment in one-third of this population. Some other studies show that a 5-year disease free survival rate was higher in those patients who had imaging done. Even though we currently don't have clear imaging guidelines for cutaneous squamous cell carcinoma, I think we should take these numbers into account and design on a case-by-case scenario of our patients.

Last, but not least, another point I'm going to touch on briefly in my session is the sentinel lymph node biopsy for squamous cell carcinoma, even though currently we're not certain where we are in numbers because the studies are very small and they're a little bit conflicting. There are some studies that show a high-risk patient may have up to one-third positivity on the central lymph node. This is very important data that we should consider, and hopefully we can continue doing more studies in this area that will be very productive.

What do you hope your colleagues take away from your session?

I hope my colleagues take home a very comprehensive guide on the current treatment guidelines and start-up care that they should employ in the treatment and follow up for cutaneous squamous cell carcinoma. Most importantly, I want to pique the interest in much needed areas of research because we need bright dermatologists around the country who have robust research units to get a little bit more interest in those areas where we still need more studies because it’s going to help our high-risk patients. I would also like them to participate in this session because I think it’s going to be a very interesting discussion.

Are there any more insights you’d like to share about your session and/or AAD?

I would like to invite all my colleagues who are going to be at AAD to our session on Saturday afternoon. We’re going to be having a very interesting and comprehensive session, and we’re hoping attendees will take home important strategies that can be used in patients who can be very challenging sometimes. As far as attending AAD, I am looking forward not only to expand some of my knowledge, but to learn from different dermatologists across the country, and what points of view they can offer on all these areas, so I can come home and start to adopt the care techniques they talked about.

Reference
Correa L. Cutaneous squamous cell carcinoma update. Presented at: AAD Annual Meeting; March 17–21, 2023; New Orleans, LA.