Immunotherapy for the Treatment of Nonmelanoma Skin Cancer

Publication Date: March 19, 2024
Last Updated: May 31, 2024

Diagnosis, workup, and initial staging for MCC

  • Histopathological diagnosis of MCC should include hematoxylin and eosin (H&E) and IHC with evaluation by a pathologist with experience in the diagnosis of skin cancers, when feasible.
  • For patients with MCC, multidisciplinary care team management is optimal.
  • Baseline imaging should be considered in all patients with MCC for the detection of metastatic disease (LE:4).
  • Baseline MCPyV oncoprotein serology testing (eg, AMERK) should be considered, as this has implications for surveillance (LE:3).
  • If, by clinical examination or imaging, a patient is suspected of having nodal or distant metastatic disease, a biopsy should be performed for histological confirmation (LE:3).
  • If imaging and clinical evaluation are negative for metastatic disease, patients should be considered for sentinel lymph node biopsy for staging (LE:1).

Recommended immunotherapies for MCC

  • For patients with metastatic, recurrent, or locally advanced MCC that is not amenable to curative surgery or radiation and for whom no contraindications to immunotherapy are present, first-line therapy with an approved anti-PD-(L)1 ICI is recommended (LE:2).
  • For patients with MCC who experience disease progression while on anti-PD-(L)1 immunotherapy, therapeutic options are limited and include the addition of an anti-CTLA-4 antibody to anti-PD-(L)1 therapy, clinical trials, or chemotherapy. Switching treatments from one anti-PD-(L)1 antibody to another anti-PD-(L)1 antibody is unlikely to be beneficial.
  • While responses to PD-(L)1 blockade are frequent and generally durable, disease progression may occur in a subset of responders, and hence, continued surveillance for MCC progression is warranted.
  • For patients with MCC being treated with anti-PD-(L)1 ICIs, there are no validated biomarkers to predict benefit (including MCPyV viral status or PD-L1 expression).



Immunotherapy for the Treatment of Nonmelanoma Skin Cancer

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