Patterns of major cutaneous surgeries and reconstructions in patients with cutaneous squamous cell carcinoma in the USA.

Cutaneous squamous cell carcinoma (CSCC) is one of the two most common cancers, and numbers of new cases are increasing each year by 3­7%. A small number of advanced cases require systemic treatments (drugs given by mouth or injection), such as chemotherapy or immunotherapy. Patients with CSCC may require major skin surgeries and reconstructions. Little is known about how these skin procedures are used to treat patients with CSCC, particularly those with a weakened immune system. This analysis used USA insurance data of patients from 2013 to 2020 to assess how they were treated with surgeries, based on patients' immune status and whether they had started systemic treatment for CSCC. Among the 450,803 patients identified with a new CSCC diagnosis, the chances of having a procedure over a 7-year period was 10.9% (around one in nine). For 4111 patients with CSCC who started systemic therapy, this was 21.8% (around one in five). The chances of having a procedure were also significantly higher in patients with a weakened immune system (14.0%, around one in seven), compared with those without. However, this study was potentially limited by the following: the study population might not fully represent the CSCC population, the risk of surgery might be underestimated and information about patients' tumors (e.g., staging) was lacking. These results suggest there is an unmet need for systemic treatments that can reduce the burden of skin surgeries and reconstructions in CSCC.