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  • Adjuvant therapy is treatment used after primary treatment to reduce the chance of cancer recurrence.

  • The use of adjuvant therapies has shown significant improvement in patient overall survival and recurrence-free survival in certain skin cancers.


  • Immune checkpoint inhibition has unlocked new adjuvant standards in skin cancer.

  • Immunotherapies in combination with standard treatments have the potential to reduce tumor burden and can be a viable option for some patients with high-risk tumors.


  • Reducing the recommended dosage for these treatments is often not recommended. Rather, delaying or terminating treatment should be considered for adverse reactions or toxicity.


  • Patients should be educated of the frequently reported side effects, as well as potential adverse or immune-mediated reactions. Patients should also be cautioned that the side effects of these novel therapies are still being studied and discovered.


Skin cancer encompasses a range of malignancies, and its incidence is increasing worldwide. It can be broadly divided into nonmelanoma (squamous cell, basal cell, Merkel cell) and melanoma subtypes. Surgical excision is the primary treatment for most skin cancers; however, it may not be sufficient to prevent relapse in more advanced stages. Thus, adjuvant therapies are often utilized to increase the efficacy of cancer treatment. Adjuvant therapy is delivered after the primary treatment with the goal of preventing relapse. In addition, neoadjuvant therapies may be utilized preoperatively to shrink the tumor and reduce surgical morbidity. This chapter discusses the role of adjuvant and neoadjuvant therapies in skin cancer based on current evidence-based recommendations. In addition, future directions for therapeutic advancements are also discussed.



Cutaneous squamous cell carcinoma (cSCC) is the second most common skin cancer and constitutes about 20% of all nonmelanoma skin cancers.1 Current research demonstrates that cSCC is diagnosed at a global rate of 15 to 35 per 100,000 people annually.1 cSCC usually presents with benign clinical behavior but can become locally invasive and metastatic. Known risk factors include old age, male sex, fair skin, immunosuppression, chronic sun exposure, and history of actinic keratosis (AK).1 AK is a premalignant lesion and is considered the most predictive factor in the development of cSCC.2

According to the American Academy of Dermatology (AAD) and National Comprehensive Cancer Network (NCCN) guidelines, the first-line treatments for local low-risk SCC include standard excision with 4- to 6-mm clinical margins and postoperative margin assessment.3 For high-risk cSCCs, Mohs micrographic surgery is associated with improved outcomes.4 Recurrent cSCCs are associated with a much worse prognosis, and recurrence is likely after excisional surgery or Mohs micrographic surgery, thus adjuvant treatment after excision should be considered.4 Radiation may be used as adjuvant therapy in some cases or as primary treatment in patients who are ...

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