Multidisciplinary Coordination and Emerging Biomarkers Transform Care for High-Risk Cutaneous Squamous Cell Carcinoma
Key Insights
Early referral of high-risk cSCC patients to radiation and medical oncology is critical to avoid care delays and preserve clinical trial eligibility, with multidisciplinary tumor boards enabling coordinated care pathways even before surgery.
Virtual tumor boards and HIPAA-secure mobile applications are expanding access to multidisciplinary expertise for community practices, allowing patients to receive local treatment while maintaining specialist involvement.
Gene expression profiling now offers prognostic risk stratification for cSCC metastasis at 3 years, while circulating tumor DNA liquid biopsy is emerging for treatment response monitoring and disease surveillance.
Multidisciplinary care coordination is reshaping the management of high-risk cutaneous squamous cell carcinoma (search) (cSCC), with experts emphasizing that early referral and integrated tumor board review can prevent treatment delays and expand patient access to clinical trials. In a recent discussion, radiation oncologist Dr. Schoenfeld underscored that patients presenting with large lesions, immunosuppression, or concern for nodal spread should be referred to radiation oncology and medical oncology at the earliest opportunity.
"Early referral is critical for patients with high-risk features to avoid delays in care and ensure clinical trial eligibility," Dr. Schoenfeld stated, noting that at his institution, high-risk patients are presented to a multidisciplinary cutaneous oncology tumor board even before surgery, establishing a coordinated care pathway from the outset.
Barriers to Equitable Care Delivery
Beyond clinical decision-making, Dr. Schoenfeld identified communication and transportation as key barriers for community clinicians managing cSCC. Early identification of high-risk patients allows time to connect them with lodging and referral resources, addressing logistical hurdles that might otherwise interrupt care. He stressed that ongoing communication—not just at initial referral but throughout surgery, radiation, and systemic therapy transitions—is essential to prevent patients from being lost between providers.
Dr. Singh reinforced this perspective, emphasizing that meeting patients where they are, not just treating the cancer, is central to equitable care delivery.
Virtual Tumor Boards Expand Access
The pandemic era brought lasting innovations to multidisciplinary coordination. Dr. Zeitouni described virtual tumor boards as a significant advancement that has improved access to multidisciplinary input across practice settings, enabling community-based dermatologists and Mohs surgeons to present cases to medical oncologists and radiation oncologists without geographic constraints.
For community practices that lack formal tumor board infrastructure, Dr. Zeitouni recommended establishing direct collegial relationships with medical oncologists who have cutaneous malignancy expertise via phone, text, or referral, achieving similar coordination benefits.
NP Schollenberger detailed the multidisciplinary model at Johns Hopkins, where a weekly tumor board includes surgeons, dermatologists, medical oncologists, and radiation oncologists, supported by direct inter-specialty communication as needed. Her team is piloting a HIPAA-secure mobile application developed through their group, 1104 Health (search), that connects community providers with academic specialists. The platform enables direct patient-level communication and allows patients to receive treatment locally while maintaining involvement of cutaneous malignancy specialists.
Emerging Biomarkers: Gene Expression Profiling and ctDNA
Dr. Zeitouni highlighted two emerging biomarker tools poised to refine cSCC management. Gene expression profiling for cSCC provides prognostic risk stratification—classifying patients as low, intermediate, or high risk of metastasis at three years—thereby guiding surveillance intensity and imaging frequency.
Circulating tumor DNA (ctDNA) liquid biopsy, which has established utility in melanoma (search) and Merkel cell carcinoma (search), is beginning to be used in cSCC for treatment response monitoring and disease surveillance using tumor-informed assays. These tools represent a shift toward more personalized, risk-adapted management strategies for patients with this common skin malignancy.
Coordinated Transitions Across the Care Continuum
The panelists agreed that seamless transitions between surgery, radiation, and systemic therapy remain a critical challenge. Dr. Schoenfeld emphasized that ongoing communication across all phases of treatment is essential, warning that without deliberate coordination, patients risk being lost between providers during care handoffs. The integration of multidisciplinary tumor boards, virtual consultation platforms, and emerging biomarker-driven risk stratification offers a framework for more connected, patient-centered cSCC care.