35317 More than meets the eye: Regression of locally advanced recurrent SCC

Abstract

A 62-year-old white man presented with a rapidly enlarging tumor of the right periorbital skin at a prior site of a cSCC. Excisional biopsy of the tumor revealed recurrent cSCC with an infiltrative growth pattern. Based on this he was referred for multidisciplinary care. Staging CT of the face showed a soft tissue mass of the right face centered at the lateral right preseptal periorbital soft tissues, extending to right frontal bone, abutting the temporalis muscle, lateral orbital rim, globe and lacrimal gland. Given the extent of involvement, the consensus was to begin systemic therapy with pembrolizumab at a dose of 400 mg intravenous administration every 6 weeks. Several weeks after the first dose, the patient was concerned since the tumor appeared to be growing. The patient then went to another institution for a second opinion and was advised to undergo orbital exenteration with lateral orbital bone resection followed by adjuvant radiation. He decided against this and continued with the pembrolizumab infusions and after his fifth dose he had complete clinical tumor regression. This case demonstrates the remarkable clinical response of recurrent SCC treated with immunotherapy while maintaining a reasonable quality of life.