Case Presentation: A 79-Year-Old Woman With Unresectable Cutaneous Squamous Cell Carcinoma

Dr Whitman presents the second clinical scenario, a 79-year-old woman with a large ulcerated cutaneous squamous cell carcinoma of the right lower leg measuring 6.8 cm and progressively enlarging over roughly 8 months. The lesion is fixed and invades the underlying fascia. Imaging shows no nodal or distant disease. Her medical history includes chronic kidney disease with approximately 50% renal function, atrial fibrillation managed with anticoagulation, hypertension, and mild thrombocytopenia, with a reasonable performance status. Surgery and radiation oncology have both determined the tumor is not resectable with acceptable morbidity. Dr In discusses why chronic kidney disease and atrial fibrillation do not by themselves preclude checkpoint inhibitor therapy, and describes his approach to bringing the case through multidisciplinary tumor board. He also raises whether radiation could serve a palliative or immune-priming role alongside systemic therapy, a question he would pose to his radiation oncology colleague.