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touchMDT Optimizing the patient journey in CSCC through multidisciplinary collaboration

In this activity, leading experts discuss optimal approaches for the management of patients with CSCC and consider how effective multidisciplinary collaboration can contribute to improved outcomes.

 Overview & Learning Objectives

Patient with locally advanced or metastatic CSCC
Dermatologist and Dermatopathologist
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Diagnostic workup in CSCC Prof. Robert, Dr Busam

A dermatologist and dermatopathologist discuss the diagnostic workup for CSCC.

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Radiation Oncologist and Head and Neck Surgeon
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CSCC treatment: Surgery or radiotherapy Dr Rembielak, Prof. Bussu

A radiation oncologist and a head and neck surgeon discuss eligibility for surgery and radiotherapy in patients with CSCC.

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Dermatologist and Dermato-oncologist
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CSCC treatment: Systemic therapy Prof. Robert, Dr Claveau

A dermato-oncologist and dermatologist consider systemic therapies for locally advanced and metastatic inoperable CSCC.

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Dermatologist, Dermatopathologist, Radiation Oncologist and Head and Neck Surgeon
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Multidisciplinary care for CSCC Prof. Robert, Dr Busam, Dr Rembielak, Prof. Bussu

Four specialists from the MDT discuss the importance of multidisciplinary collaboration for patients with CSCC.

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Dermatologist and Dermatopathologist

A dermatologist and dermatopathologist discuss the diagnostic workup for CSCC.
Expert Spotlight
Prof. Caroline Robert
Gustave Roussy, Villejuif, France
Dr Klaus Busam
Memorial Sloan Kettering Cancer Center, New York, NY, USA

Prof. Caroline Robert and Dr Klaus Busam discuss the key recommendations for the diagnostic workup of patients with suspected CSCC who present for biopsy, and consider how to accurately assess prognostic factors while identifying the key stakeholders involved in this crucial stage in the patient’s journey.

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 Learn more Back to MDT Hub Time: 12:21
 
Radiation Oncologist and Head and Neck Surgeon

A radiation oncologist and a head and neck surgeon discuss eligibility for surgery and radiotherapy in patients with CSCC.
Expert Spotlight
Dr Agata Rembielak
The Christie NHS Foundation Trust, Manchester, UK
Prof. Francesco Bussu
Università degli Studi di Sassari, Sassari, Italy

Dr Agata Rembielak and Prof. Francesco Bussu discuss the considerations to assess eligibility for surgery or radiotherapy in patients with a confirmed diagnosis of CSCC, illustrated using a patient case.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:00
 
Dermatologist and Dermato-oncologist

A dermato-oncologist and dermatologist consider systemic therapies for locally advanced and metastatic inoperable CSCC.
Expert Spotlight
Prof. Caroline Robert
Gustave Roussy, Villejuif, France
Dr Joël Claveau
Laval University, Quebec City, Canada

Dr Joël Claveau and Prof. Caroline Robert consider when to use systemic therapies to treat patients with locally advanced or metastatic CSCC, using a patient case to illustrate the emerging role of immunotherapy in clinical practice.

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 Learn more Back to MDT Hub Time: 13:43
 
Dermatologist, Dermatopathologist, Radiation Oncologist and Head and Neck Surgeon

Four specialists from the MDT discuss the importance of multidisciplinary collaboration for patients with CSCC.
Expert Spotlight
Prof. Caroline Robert
Gustave Roussy, Villejuif, France
Dr Klaus Busam
Memorial Sloan Kettering Cancer Center, New York, NY, USA
Dr Agata Rembielak
The Christie NHS Foundation Trust, Manchester, UK
Prof. Francesco Bussu
Università degli Studi di Sassari, Sassari, Italy

Prof. Caroline Robert, Dr Klaus Busam, Dr Agata Rembielak and Prof. Francesco Bussu discuss the role of the multidisciplinary team in the care of patients with CSCC and how effective collaboration can improve outcomes for these patients.

Listen on the Go

 Learn more Back to MDT Hub Time: 12:07
 
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Overview & Learning Objectives
Overview

Watch leading specialists involved in the management of patients with cutaneous squamous cell carcinoma (CSCC) explore key aspects of the patient journey, including diagnostic workup, eligibility for surgery and radiotherapy, when to use systemic therapies, and the importance of effective multidisciplinary collaboration.

This activity is jointly provided by USF Health and touchIME. read more

Target Audience

This activity has been designed to meet the educational needs of oncologists, dermatologists, radiation oncologists and immunologists involved in the management of CSCC worldwide.

Disclosures

USF Health adheres to the Standards for Integrity and Independence in Accredited Continuing Education. All individuals in a position to influence content have disclosed to USF Health any financial relationship with an ineligible organization. USF Health has reviewed and mitigated all relevant financial relationships related to the content of the activity.  The relevant relationships are listed below. All individuals not listed have no relevant financial relationships.

Faculty

Prof. Caroline Robert discloses: Advisory board or panel fees from Bristol Myers Squibb, Novartis, Pierre Fabre and Roche. Consultancy fees from Merck, MSD and Sanofi. Shareholder in Ribonexus.

Prof. Klaus Busam discloses: Advisory board or panel fees from Dermtech Inc.

Dr Agata Rembielak has no interests/relationships or affiliations to disclose in relation to this activity.

Prof. Francesco Bussu has no interests/relationships or affiliations to disclose in relation to this activity.

Dr Joël Claveau discloses: Advisory board or panel fees from Bristol Myers Squibb, Merck and Sanofi-Genzyme. Consultancy fees from Bristol Myers Squibb, Merck and Sanofi-Genzyme. Grants/Research support from Bristol Myers Squibb and Merck.

Content reviewer

Angela Hill, PharmD has no financial interests/relationships or affiliations in relation to this activity

Touch Medical Director

Adriano Boasso and Kathy Day have no financial interests/relationships or affiliations in relation to this activity.

USF Health Office of Continuing Professional Development and touchIME staff have no financial interests/relationships or affiliations in relation to this activity.

Requirements for Successful Completion

In order to receive credit for this activity, participants must review the content and complete the post-test and evaluation form. Statements of credit are awarded upon successful completion of the post-test and evaluation form.

If you have questions regarding credit please contact cpdsupport@usf.edu 

Accreditations

Physicians

This activity has been planned and implemented in accordance with the accreditation requirements and policies of the Accreditation Council for Continuing Medical Education (ACCME) through a joint providership of USF Health and touchIME. USF Health is accredited by the ACCME to provide continuing medical education for physicians.

USF Health designates this enduring material for a maximum of 1.0 AMA PRA Category 1 CreditTM.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

The European Union of Medical Specialists (UEMS) – European Accreditation Council for Continuing Medical Education (EACCME) has an agreement of mutual recognition of continuing medical education (CME) credit with the American Medical Association (AMA). European physicians interested in converting AMA PRA Category 1 CreditTM into European CME credit (ECMEC) should contact the UEMS (www.uems.eu)

Advanced Practice Providers

Physician Assistants may claim a maximum of 1.0 Category 1 credits for completing this activity. NCCPA accepts AMA PRA Category 1 CreditTM from organizations accredited by ACCME or a recognized state medical society.

The AANPCP accepts certificates of participation for educational activities approved for AMA PRA Category 1 CreditTM by ACCME-accredited providers. APRNs who participate will receive a certificate of completion commensurate with the extent of their participation.

Date of original release: 22 March 2022. Date credits expire: 22 March 2023.

If you have any questions regarding credit please contact cpdsupport@usf.edu

Learning Objectives

After watching this activity, participants should be better able to:

  • Define multidisciplinary best practices for diagnostic workup of cutaneous squamous cell carcinoma (CSCC) and identification of risk factors influencing prognosis
  • Outline interdisciplinary eligibility criteria for surgery and radiotherapy in patients with CSCC
  • Determine the optimal use of systemic therapies in patients with unresectable locally advanced or metastatic CSCC and the role of the multidisciplinary tumour board in sharing clinical decisions in cancer care
Faculty & Disclosures
Prof. Caroline Robert

Gustave Roussy, Villejuif, France

Prof. Caroline Robert is Head of the Dermatology Service at Gustave Roussy Cancer Campus and Co-director of the Melanoma Research Unit at INSERM 981 Paris-Sud University. read more

She is a full professor of dermatology and is responsible for teaching dermatology and dermato-oncology at the Paris-Saclay University School of Medicine. Her main interests are clinical and translational research on melanoma and non-melanoma skin cancers involving immunotherapy and targeted therapy.

She has authored more than 400 articles in peer-reviewed scientific journals and has received several awards and prizes, including the Estela Medrano Award from the Society for Melanoma Research in 2018 and the European Society of Medical Oncology Woman Award in 2020.

Prof. Caroline Robert discloses: Advisory board or panel fees from Bristol Myers Squibb, Novartis, Pierre Fabre and Roche. Consultancy fees from Merck, MSD and Sanofi. Shareholder in Ribonexus. 
Dr Klaus Busam

Memorial Sloan Kettering Cancer Center, New York, NY, USA

Dr Klaus Busam is Professor of Pathology and Laboratory Medicine at the Weill Medical College of Cornell University and Director of Dermatopathology at the Memorial Sloan Kettering Cancer Center in New York, USA. read more

Dr Busam’s academic work has largely been focused on improvements in the diagnostic accuracy and prognosis of melanocytic tumours and other skin cancers through clinicopathologic correlations and the use of ancillary methods.

He has authored more than 400 publications in peer-reviewed journals. He has also edited, co-edited or contributed chapters to leading textbooks in melanocytic tumour pathology, general dermatopathology and to the book WHO Classification of Skin Tumours.  

He serves on the International Collaboration on Cancer Reporting (ICCR) expert committee for melanoma and chairs the ICCR expert committee for Merkel cell carcinoma. For his academic contributions, he received the prestigious Founders Award of the American Society of Dermatopathology in 2021.

Prof. Klaus Busam discloses: Advisory board or panel fees from Dermtech Inc.
Dr Agata Rembielak

The Christie NHS Foundation Trust, Manchester, UK

Dr Agata Rembielak is Clinical and Radiation Oncology Consultant at the Christie Hospital in Manchester and Honorary Senior Clinical Lecturer at the University of Manchester in the UK. read more

Her research interests include non-melanoma skin cancer, particularly the role of radiotherapy and brachytherapy in skin cancer management, palliative radiotherapy and geriatric oncology.

In the UK, she sits on the National Cancer Research Institute Skin Cancer Group and leads on radiation oncology studies. Internationally, she is a director at the European Society of Radiation Oncology (ESTRO) skin cancer course and sits on the Groupe Européen de Curiethérapie (GEC)-ESTRO Head and Neck and Skin Working Group (Skin Lead and Secretary). She also chairs the International Society of Geriatric Oncology Task Force on non-melanoma skin cancer in older adults.

Dr Agata Rembielak has no interests/relationships or affiliations to disclose in relation to this activity.
Prof. Francesco Bussu

Università degli Studi di Sassari, Sassari, Italy

Prof. Francesco Bussu is Professor of Otolaryngology at the Università degli Studi di Sassari in Italy. read more

He has authored more than 90 articles in peer-reviewed scientific journals, primarily focused on head and neck surgery and oncology; in particular, virus-induced carcinogenesis, interventional radiotherapy (brachytherapy), as well as rhinology, phoniatrics and general otolaryngology. 

He is the principal investigator in nine grants from the Italian university system, from the Fondazione Banco di Sardegna and from Sardegna Ricerche since 2012, and serves as a reviewer on several international scientific journals including Cancer Research, Clinical Cancer Research and Carcinogenesis. 

Prof. Francesco Bussu has no interests/relationships or affiliations to disclose in relation to this activity.
Dr Joël Claveau

Laval University, Quebec City, Canada.

Dr Joël Claveau is Associate Professor at the Department of Medicine, Laval University, Quebec City, Canada. read more

Dr Claveau specializes in the diagnosis and treatment of melanoma and non-melanoma skin cancers. He has contributed to the publication of papers in peer-reviewed journals, including work on melanoma, skin cancers and sunscreens. He is actively involved in various continuing medical education events and is an investigator in many clinical trials on advanced and metastatic melanoma.

Dr Claveau is a diplomat of the American Board of Dermatology and is a member of a number of medical societies, including the American Academy of Dermatology and the International Dermoscopy Society. He has received awards, including Honorary Member of La Société Française de Dermatologie, the Dermatologist’s Volunteer Award of the Canadian Dermatology Association (CDA) for his work on the prevention of skin cancers, and the CDA Symposium of the year on two occasions (Dermoscopy).

Dr Joël Claveau discloses: Advisory board or panel fees from Bristol Myers Squibb, Merck and Sanofi-Genzyme. Consultancy fees from Bristol Myers Squibb, Merck and Sanofi-Genzyme. Grants/Research support from Bristol Myers Squibb and Merck.
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This Activity Is Funded By:

An independent medical education grant from Regeneron Pharmaceuticals, Inc. and Sanofi Genzyme.
This medical education is jointly provided by USF Health and touchIME.

The information provided by this CME activity is for continuing education purposes only and is not meant to substitute for the independent medical/clinical judgment of a healthcare provider relative to diagnostic and treatment options of a specific patient’s medical condition.

USF is an Equal Opportunity / Affirmative Action / Equal Access Institution.

USF Health is accredited by the Accreditation Council for Continuing Medical Education, the American Nurses Credentialing Center and the Accreditation Council for Pharmacy Education to provide continuing education to healthcare professionals. As an accredited provider, USF Health is required to disclose personal information to relevant accredited bodies that certify CME to process credits/contact hours, comply with reporting requirements, and for internal recordkeeping and regulatory purposes. USF Health does not share or sell any individual’s contact information or unique identifiers to any commercial supporter, advertiser, or third party without the specific permission of the individual.

Unapproved products or unapproved uses of approved products may be discussed by the faculty; these situations may reflect the approval status in one or more jurisdictions. The presenting faculty have been advised by touchIME and USF Health to ensure that they disclose any such references made to unlabelled or unapproved use. No endorsement by touchIME or USF Health of any unapproved products or unapproved uses is either made or implied by mention of these products or uses in touchIME or USF Health activities. touchIME and USF Health accept no responsibility for errors or omissions.

This content is intended for healthcare professionals.

Date of original release: 22 March 2022. Date credits expire: 22 March 2023

This content is intended for healthcare professionals only. Please confirm that you are a healthcare professional.

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Question 1/5
When you assess tumour-associated risk factors for CSCC, a patient presenting with which of the following tumours has the highest risk of poor prognosis?

CSCC, cutaneous squamous cell carcinoma.
 Correct

A universally accepted staging system for risk stratification in CSCC is not currently available.1 However, commonly used staging systems include those of the American Joint Committee on Cancer, Brigham and Women’s Hospital, and the NCCN.2–4 There is variation across these systems, but all include tumour width of ≥2 cm, perineural invasion and poorly differentiated cells as risk factors for poor prognosis.1–4 

Abbreviations

CSCC, cutaneous squamous cell carcinoma; NCCN, National Comprehensive Cancer Network.

References

  1. Claveau J, et al. Curr Oncol. 2020;27:e399–407.
  2. NCCN Clinical Practice Guidelines in Oncology: Squamous Cell Skin Cancer. Version. 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/squamous.pdf (accessed 17 February 2022). 
  3. Farasat S, et al. J Am Acad Dermatol. 2011;64:1051–9.
  4. Jambusaria-Pahlajani A, et al. JAMA Dermatol. 2013;149:402–10.
Question 2/5
Which of the following statements best differentiates a shave biopsy from other biopsy procedures?
 Correct

The recommended biopsy techniques for CSCC are punch biopsy, shave biopsy or excisional biopsy.1 For lesions located in a prominent area where cosmetic or functional implications are a concern, a shave biopsy should be considered because it limits the size of the wound created, simplifying wound care and maintaining cosmesis.2 

Punch biopsies may be used for lesions that require dermal or subcutaneous tissue for diagnosis, which are not collected with a shave biopsy.2,3 An excisional biopsy allows the removal of an entire lesion, removing tissue up to the the subcutis plane,3 which means there is a large amount of tissue for pathological evaluation. 

Abbreviation

CSCC, cutaneous squamous cell carcinoma. 

References

  1. Claveau J, et al. Curr Oncol. 2020;27:e399–407.
  2. Pickett H. Am Fam Physician. 2011;84:995–1002.
  3. Nischal, et al. J Cutan Aesthet Surg. 2008;1:107–11.
Question 3/5
Your patient is a 72-year-old male diagnosed with a CSCC on the right nasal alar crest. The malignant lesion is 2.3 cm in diameter, with bone invasion but not perineural invasion. Which considerations should members of the MDT make when discussing treatment options with this patient?

CSCC, cutaneous squamous cell carcinoma; MDT, multidisciplinary team.
Correct

Currently, there are no published guidelines/recommendations on how to determine eligibility for surgery in a patient with advanced CSCC. Eligibility for surgery should be based on the morbidity of the procedure and the feasibility of removing the tumour with clear margins, the likelihood of achieving a cure, the potential for the excision to heal, the capacity of the patient to tolerate adjuvant radiotherapy if needed, patient age, the physical and mental state of the patient, and the patient’s ability to accept the outcomes associated with the surgery. It is important to discuss loss-of-function and cosmetic morbidities with the patient when choosing the treatment plan and to consider the risk-benefit ratio for each individual case.

Abbreviation

CSCC, cutaneous squamous cell carcinoma.

Reference

Claveau J, et al. Curr Oncol. 2020;27:e399–407.

Question 4/5
Which of the following statements about the use of systemic therapy in patients with CSCC is true?

CSCC, cutaneous squamous cell carcinoma.
 Correct

The primary treatment options for CSCC are excision by standard technique or Mohs micrographic surgery. Radiation therapy is reserved for adjuvant treatment of high-risk tumours or for patients who are not surgical candidates. Specific tumour characteristics and comorbidities render some patients with advanced CSCC ineligible for both curative surgery or curative radiotherapy. These patients, as well as those with metastatic, recurrent, and refractory disease are considered candidates for systemic therapies.

Abbreviation

CSCC, cutaneous squamous cell carcinoma.

Reference

Claveau J, et al. Curr Oncol. 2020;27:e399–407.

Question 5/5
Your patient is a 75-year-old man diagnosed with recurrent locally advanced CSCC in the right periocular area. The original tumour was deemed unresectable due to its proximity to the eye and was treated with radiotherapy. The recurrent lesion is also inoperable and curative radiotherapy is excluded due to the previous irradiation in the same location. How do you proceed?

CSCC, cutaneous squamous cell carcinoma; EGFR, epidermal growth factor receptor.
 Correct

Cemiplimab is recommended by both European and US guidelines as first-line systemic treatment for patients with locally advanced or metastatic CSCC not eligible for curative surgery or radiotherapy.1,2 Cemiplimab is approved by the FDA and the EMA as monotherapy for the treatment of patients with locally advanced or metastatic CSCC who are ineligible for curative surgery or curative radiation.3,4 In a recent clinical trial of cemiplimab, 46.1% of patients with locally advanced or metastatic CSCC achieved an objective response rate at a median follow-up of 15.7 months.5 Pembrolizumab is approved by the FDA only, based on the results of a phase II trial, which demonstrated an objective response rate of 50.0% in the locally advanced group versus 35.2% in the recurrent/metastatic group.6  

Abbreviations

CSCC, cutaneous squamous cell carcinoma; EMA, European Medicines Agency; FDA, US Food and Drug Administration; NCCN, National Comprehensive Cancer Network.

 

References 

  1. Stratigos AJ, et al. Eur J Cancer. 2020;128:83–102.
  2. NCCN Clinical Practice Guidelines in Oncology: Squamous Cell Skin Cancer. Version. 1.2022. Available at: www.nccn.org/professionals/physician_gls/pdf/squamous.pdf (accessed 17 February 2022). 
  3. FDA. Cemiplimab Prescribing Information. 2021. Available at: www.accessdata.fda.gov/drugsatfda_docs/label/2021/761097s007lbl.pdf (accessed 21 February 2022).
  4. EMA. Cemiplimab Summary of Product Characteristics. 2021. Available at: www.ema.europa.eu/en/documents/product-information/libtayo-epar-product-information_en.pdf (accessed 21 February 2022).
  5. Rischin D, et al. J Immunother Canc. 2021;9:e002757.
  6. Hughes BGM, et al. Ann Oncol. 2021;32:1276–85.
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