In order to update recommendations on treatment, supportive care, education and follow-up of patients with invasive cutaneous squamous cell carcinoma (cSCC), a multidisciplinary panel of experts from the European Dermatology Forum, the European Association of Dermato-Oncology and the European Organization of Research and Treatment of Cancer was formed. Recommendations were based on evidence-based literature review, guidelines and expert consensus. Treatment recommendations are presented for common primary cSCC (low risk, high risk), locally advanced cSCC, regional metastatic cSCC (operable or inoperable) and distant metastatic cSCC. For common primary cSCC (the most frequent cSCC type), first-line treatment is surgical excision with postoperative margin assessment or microscopically controlled sugery. Safety margins containing clinical normal-appearing tissue around the tumour during surgical excision and negative margins as reported in the pathology report are necessary to minimise the risk of local recurrence and metastasis. In case of positive margins, a re-excision shall be done, for operable cases. Lymph node dissection is recommended for cSCC with cytologically or histologically confirmed regional nodal involvement. Radiotherapy should be considered as curative treatment for inoperable cSCC, or for non-surgical candidates. Anti-PD-1 antibodies are the first-line systemic treatment for patients with metastatic or locally advanced cSCC who are not candidates for curative surgery or radiation, with cemiplimab being the first approved systemic agent for advanced cSCC by the Food and Drug Administration/European Medicines Agency. Second-line systemic treatments for advanced cSCC include epidermal growth factor receptor inhibitors (cetuximab) combined with chemotherapy or radiation therapy. Multidisciplinary board decisions are mandatory for all patients with advanced disease who require more than surgery. Patients should be engaged with informed decisions on management and be provided with best supportive care to optimise symptom management and improve quality of life. Frequency of follow-up visits and investigations for subsequent new cSCC depend on underlying risk characteristics.

中文翻译：

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欧洲关于皮肤浸润性鳞状细胞癌的跨学科指南：第2部分。

为了更新有关浸润性皮肤鳞状细胞癌（cSCC）患者的治疗，支持治疗，教育和随访的建议，欧洲皮肤病学论坛，欧洲皮肤肿瘤学协会和欧洲组织的多学科专家小组癌症研究与治疗学院成立。建议基于循证文献综述，指南和专家共识。针对常见的原发性cSCC（低风险，高风险），局部晚期cSCC，区域转移性cSCC（可操作或不可操作）和远处转移性cSCC提出了治疗建议。对于常见的原发性cSCC（最常见的cSCC类型），一线治疗是手术切除，并进行术后切缘评估或显微手术。为了最小化局部复发和转移的风险，必须有安全切缘，包括手术切除过程中肿瘤周围临床正常出现的组织以及病理报告中报告的负切缘。如果边距为正，则对于可操作的情况应重新切除。对于具有细胞学或组织学证实的区域淋巴结转移的cSCC，建议进行淋巴结清扫术。对于不能手术的cSCC或非手术候选人，应考虑放疗。抗PD-1抗体是转移性或局部晚期cSCC患者的一线全身治疗，这些患者不适合进行根治性手术或放射治疗，西米普利单抗是美国食品药品监督管理局（FDA）批准的首例用于晚期cSCC的全身药物药品管理局。晚期cSCC的二线全身治疗包括表皮生长因子受体抑制剂（cetuximab）联合化学疗法或放射疗法。对于所有需要手术以外治疗的晚期疾病，所有患者都必须做出多学科董事会决定。患者应做出明智的治疗决策，并获得最佳支持治疗，以优化症状管理并改善生活质量。对后续新的cSCC进行随访和调查的频率取决于潜在的风险特征。患者应做出明智的治疗决策，并获得最佳支持治疗，以优化症状管理并改善生活质量。对后续新的cSCC进行随访和调查的频率取决于潜在的风险特征。患者应做出明智的治疗决策，并获得最佳支持治疗，以优化症状管理并改善生活质量。对后续新的cSCC进行随访和调查的频率取决于潜在的风险特征。