KEY TAKEAWAYS

• Management of cutaneous squamous cell carcinoma (cSCC) should be individualized, with treatment decisions guided by tumor risk, patient comorbidities, functional status, and goals of care.
• In selected low-risk or elderly patients, less invasive approaches such as therapeutic biopsy or topical therapy for SCC in situ may reduce treatment burden while maintaining acceptable outcomes.
• • Neoadjuvant immunotherapy, particularly with programmed cell death 1 (PD-1) inhibitors, is an emerging option for high-risk, borderline resectable tumors and may improve surgical outcomes while enabling treatment de-escalation.
• Adjunctive tools such as gene expression profiling and preoperative imaging can refine risk stratification and guide decision-making regarding adjuvant radiation therapy and staging.
• • Adjuvant immunotherapy is now an evidence-based option for patients with high-risk cSCC following surgery and radiation, significantly improving disease-free survival.