Cutaneous squamous cell carcinoma that has become locally advanced or metastatic sits at the center of new Dermatology Times coverage examining what the dermatologist's role should be once the disease escapes routine surgical management.

The piece, published under the headline "Dermatologists' Role in Locally Advanced and Metastatic cSCC," tackles a question that has grown more pressing as treatment options for advanced disease have expanded beyond excision and radiation. Immunotherapy changed the advanced cSCC treatment conversation. Dermatology now has to decide how far into that conversation it stays.

Why cSCC staging language matters here

Locally advanced cSCC covers tumors that are unresectable, or that would require disfiguring surgery to remove, while metastatic disease implies spread to regional nodes or distant sites. The distinction drives everything downstream: who manages the patient, which therapies apply, and how the dermatologist coordinates with surgical, radiation and medical oncology colleagues.

Dermatologists remain the specialists who most often make the initial diagnosis, and that position gives them leverage over how quickly high-risk cases get flagged, staged and referred. The coverage asks what that leverage obligates the field to do.

What does this change for practicing dermatologists?

The practical question the article raises for clinicians is where dermatology's responsibility ends in advanced disease — and the answer it develops is that it doesn't simply end at referral. Follow-up surveillance, management of treatment-related skin toxicity, and ongoing assessment of the primary site and regional draining beds typically loop back to the dermatologist.

For a specialty that owns the diagnosis, that ownership carries through the disease course:

• identifying high-risk tumor features at biopsy and histopathology review
• determining when a case exceeds what office-based surgery can safely address
• coordinating multidisciplinary input before irreversible surgical decisions
• continuing cutaneous surveillance in patients on systemic therapy, who remain at elevated risk for subsequent skin cancers

A disease the field can't hand off entirely

Advanced cSCC is uncommon relative to the hundreds of thousands of keratinocyte carcinomas diagnosed annually, but the metastatic subset is where mortality concentrates, and where delays in recognition cost the most. That asymmetry — rare outcomes, high stakes — is what keeps the dermatologist relevant even after the case moves into oncology's territory.

The Dermatology Times discussion arrives as the field continues to debate formal training expectations around systemic therapy prescriptive authority and tumor board participation for dermatologists. Readers looking for the full argument, including the clinical scenarios the author works through, will find it in the original coverage.

Expect the specialty's role in advanced cSCC to keep widening as more systemic agents enter practice and as payers and guidelines formalize who may prescribe and monitor them.