This handout is for cutaneous squamous cell carcinoma. Your care team identified this based on: persistent hyperkeratotic firm and often tender plaque or nodule on chronically uv-exposed skin (nccn cscc 2025).
Other reasons your team may use this plan: rapidly growing crateriform nodule with central keratin plug (keratoacanthoma-like cscc variant) (nccn cscc 2025); non-healing chronic ulcer, or new lesion arising in a burn / scar / chronic wound (marjolin ulcer) — high-risk cscc entry (nccn cscc 2025); erythematous scaly well-demarcated patch or plaque persisting for months — scc in situ (bowen disease) (nccn cscc 2025).
Take these medications exactly as prescribed. Do not stop or change a dose without talking to your provider.
| Medication | Starting dose | How | When | What it does |
|---|---|---|---|---|
| standard_surgical_excision_4_to_6mm_margin | — | — | — | NCCN cSCC 2025 — standard excision with 4-6 mm clinical margins achieves ~95% cure in low-risk primary cSCC; 6 mm preferred for tumours 1-2 cm. |
| electrodesiccation_and_curettage | — | — | — | NCCN cSCC 2025 — ED&C for low-risk small cSCC on non-terminal-hair-bearing skin; avoid on scalp / beard area and any high-risk feature. |
| fluorouracil | 5% cream | topical | BID x 2-4 weeks (in situ) | NCCN cSCC 2025 — topical 5-FU 5% for SCC in situ (Bowen) only; not for invasive cSCC; expect erosion / inflammation. |
| imiquimod | 5% cream | topical | 5x/week x 12-16 weeks (in situ) | NCCN cSCC 2025 — topical imiquimod 5% for SCC in situ (Bowen) only; not for invasive cSCC; brisk inflammation expected. |
| photodynamic_therapy | — | — | — | NCCN cSCC 2025 — PDT (ALA / MAL) for SCC in situ and AK field; not for invasive cSCC. |
| cryosurgery | — | — | — | NCCN cSCC 2025 — cryosurgery is an option for selected small SCC in situ when surgery is declined / unfeasible. |
Plan: cSCC — risk-directed treatment ladder (NCCN cSCC 2025; Brigham staging; EMPOWER-CSCC-1; KEYNOTE-629)
Contact your care team if any of the following happen:
Call 911 or go to the nearest emergency room right away if you have:
Lifelong derm continuity with emphasis on photoprotection (broad-spectrum SPF ≥30 + sun-protective clothing + behavioural avoidance), structured skin self-examination + regional-node self-check education, AK / field-therapy maintenance (route derm.actinic-keratosis-nmsc.core.v1 for ongoing field treatment), and nicotinamide chemoprevention for transplant recipients / multiple prior NMSC (ONTRAC PMID 26488693). Organ-transplant recipients receive intensified surveillance + transplant-team coordination on immunosuppression. Recurrence at the prior site -> re-biopsy + escalate (Mohs re-excision, adjuvant RT, or systemic therapy if unresectable).
Guideline: NCCN Squamous Cell Skin Cancer v.1.2025 (NCCN.org) + Brigham T-stage outcomes (Schmults/Karia JAMA Dermatol 2013; PMID 23677079, DOI 10.1001/jamadermatol.2013.2139) + EMPOWER-CSCC-1 cemiplimab in metastatic / locally advanced cSCC (Migden NEJM 2018; PMID 29863979, DOI 10.1056/NEJMoa1805131) + KEYNOTE-629 pembrolizumab in R/M cSCC primary (Grob JCO 2020; PMID 32673170, DOI 10.1200/JCO.19.03054) and combined LA + R/M (Hughes Ann Oncol 2021; PMID 34293460, DOI 10.1016/j.annonc.2021.07.008) + ONTRAC nicotinamide chemoprevention (Chen NEJM 2015; PMID 26488693, DOI 10.1056/NEJMoa1506197)