How would you manage a large area of multiple, recurrent cutaneous squamous cell carcinomas of the scalp with ulcerations and non-healing areas despite cryotherapy, multiple Mohs procedures, and 5-FU?   

Consider sending the patient to medical oncology for evaluation for cemiplimab. Large areas of the scalp can also be treated by making a 1 cm "cap" of bolus and utilizing VMAT to cover scalp soft tissues, with elective coverage of nodes and perineural pathways if indicated. 

I have had a few patients with too numerous to count large, painful SCCs refractory to local therapy, radiation, etc. All were 85 years old plus. All responded very well to immunotherapy (either pembro or cemiplimab).

Often the cause of poor wound healing is the cancer itself so while treatment can either have a negative or positive impact on healing, curing the cancer is key. Depending on the size and extent of the area surface, brachytherapy with a 3D-printed mold could be an option. Hyperbaric oxygen, wound ca...

It is not clear why the patient is on hydroxyurea. This underlying condition may inform treatment decisions. With an immune suppressive disease, it is not clear how efficacious immune-based systemic therapies would be. A significant portion of immune-competent patients may progress on cemiplimab wit...

Radiation unenthusiastically due to the risk of bone exposure 

Radiation therapy, possible with the addition of cemiplimab (Libtayo). Hydroxyurea should have no effect on either therapy.

Very complicated patient to manage -- immunosuppressed with multiple recurrent SCCs of the scalp. My first question would be to know if any of the tumors are high-risk SCCs or in-transit metastases as this would drastically change my approach, surveillance, and management. I would work with medical ...

I cover a department in Kutaisi, Georgia where I see many advanced skin cancers. There is likely for advanced surgical techniques and no access to biological therapy. I have one patient with a large SCC scalp tumor that responded to 70 Gy. One year later, there was no skin growth and skull exposure....