Use of Cemiplimab in Locally Advanced Cutaneous Squamous Cell Carcinoma

Background: Cutaneous Squamous Cell Carcinoma (cSCC), is one of the major types of skin cancer, along with basal cell cancer and melanoma. It usually presents as a hard lump with a scaly top but can also form as an ulcer. The greatest risk factor is high total exposure to ultraviolet radiation from the sun. Squamous cell carcinomas are generally treated by surgical excision, Mohs surgery or electrodessication and curettage. Non-surgical options for the treatment of cSCC include topical chemotherapy, topical immune response modifiers, Photodynamic Therapy (PDT), radiotherapy, and systemic chemotherapy. Patient and Methods: The patient was a 92-year old female with cSCC at the left side of frontal bone, which was removed a few times by surgery. In July 2018, a last attempt at removal was made, R2 resection with penetration versus meningeal tissue. She was irradiated in this area with 70Gy, achieving reduction of the tumor mass and relief. In May 2018, upon tumor progression, cemiplimab (Libtayo) treatment was suggested. Results: After 6 cycles of treatment, more than 50% tumor reduction (as shown by MRI) was seen, along with partial healing of wounds caused by bone destruction. Adverse effects appeared with a cutaneous rash, Grade IV, after the 5th cycle, treated successfully with prednisone. Conclusion: The use of Cemiplimab is safe and effective and needs to be considered as a first-line treatment in such cases.