Squamous cell carcinoma is the skin cancer most people shrug off until it stops playing by the rules. From the AOCD meeting in Orlando, I sit down with board-certified dermatologist and Mohs surgeon Dr. Carlos Gomez Mead to talk about why cutaneous squamous cell carcinoma can be far more dangerous than its reputation and why, on a population level, it can lead to more deaths than melanoma.
We dig into what actually makes a squamous cell carcinoma “high risk” in real life: rapid growth, pain with pressure that can hint at perineural invasion, and high risk head and neck locations where lymphatic spread is a real concern. We also talk candidly about the shortcomings of common staging systems (NCCN, AJCC, and BWH) and why clinical judgment still matters when cancer behavior is unpredictable.
Then we get practical about gene expression profiling for squamous cell carcinoma, including DecisionDx-SCC (a 40-gene test run on the original biopsy tissue). Dr. Gomez Mead breaks down results in plain language: low, medium, and high risk, and how those categories can change what we do next, from imaging surveillance and oncology collaboration to when adjuvant radiation therapy may actually help. We also spend time on immunosuppressed patients, especially transplant recipients, and why proactive planning can be lifesaving.
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