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A Case Report of Unresectable Cutaneous Squamous Cell Carcinoma Responsive to Pembrolizumab, a Programmed Cell Death Protein 1 Inhibitor

Anne Lynn S. Chang, MD1; Jinah Kim, MD, PhD1,2; Richard Luciano, NP3; Loretta Sullivan-Chang, MD3; Alexander D. Colevas, MD3
[+] Author Affiliations
1Department of Dermatology, Stanford University School of Medicine, Redwood City, California
2Department of Pathology, Stanford University School of Medicine, Palo Alto, California
3Department of Medicine–Head and Neck Oncology, Stanford University School of Medicine, Stanford, California
JAMA Dermatol. 2016;152(1):106-108. doi:10.1001/jamadermatol.2015.2705.
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This case report describes the successful treatment of unresectable cutaneous squamous cell carcinoma with pembrolizumab, a programmed cell death protein 1 inhibitor.

Unresectable cutaneous squamous cell carcinomas (SCCs) can be difficult to treat: only about 30% of patients respond to any type of current treatment.1 Substantial progress has recently been made in the development of immunotherapy for the treatment of cancer. In particular, checkpoint blockade using antibodies that impede immune inhibitory pathways, such as programmed cell death protein 1 (PD-1)/PD-1 ligand 1 (PD-L1), represents a novel strategy.

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Figure 1.
Magnetic Resonance Imaging (MRI) of Unresectable Cutaneous Squamous Cell Carcinoma

A, Coronal MRI with contrast shows an abnormal enhancing soft tissue mass to the right of the Meckel cave measuring 1.4 × 1.8 cm (arrowhead). B, Axial MRI with contrast shows the same mass (arrowhead). There was enhancement within the cisternal segment of cranial nerve V, Meckel cave, and right middle fossa dura consistent with tumor involvement. C and D, After treatment with 3 cycles of a programmed cell death protein 1 (PD-1) inhibitor, the coronal (C) and axial (D) MRIs with contrast show reduction of soft tissue bulk consistent with treatment response (arrowheads). In addition, there was reduced enhancement within the right facial nerve at the genu and descending segment consistent with response to treatment. There was also reduced enhancement within the cisternal segment of cranial nerve V, Meckel cave, and right middle fossa dural-based thickening, which indicates markedly regressed tumor involvement.

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Figure 2.
Unresectable Cutaneous Squamous Cell Carcinoma Specimens With Strong Immunostaining of Programmed Cell Death Protein 1 Ligand 1 (PD-L1)

A, Biopsy specimen of the patient’s unresectable cutaneous squamous cell carcinoma (SCC) prior to treatment with pembrolizumab. B, Immunostaining of another SCC biopsy specimen shows a strong signal on the tumor cells (original magnification ×200 for both images).

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