Clinical Scenario 1: High-Risk Adjuvant Setting in cSCC Treatment

Dr. Singh presents Scenario 1: a 68-year-old male, former smoker, with ECOG PS 0, who underwent surgical resection and adjuvant radiation for cSCC of the right parotid region with extracapsular nodal extension and two lymph nodes each >20 mm. Post-radiation imaging shows no residual or metastatic disease. Normal organ function. Radiation completed 5 weeks prior.

Dr. Sondak reflects that this patient represents an opportunity to have considered neoadjuvant therapy earlier in the care pathway. He introduces a practical risk stratification framework: low-risk tumors are managed with simple excision; high-risk tumors may require Mohs or comprehensive margin assessment; very high-risk tumors may warrant adjuvant radiation; and "extremely high-risk" patients, like this one, have undergone surgery and radiation and still face significant risk of systemic recurrence. For this group, adjuvant cemiplimab offers a meaningful reduction in recurrence risk. He emphasizes that patients must understand their risk and be part of the decision-making process, weighing the option of proactive adjuvant therapy versus watchful waiting.

Dr. Singh confirms that this patient meets C-POST eligibility criteria based on extracapsular extension, and reiterates the value of risk stratification in guiding adjuvant therapy decisions.