Stage T3N1M0 recurrent cutaneous SCC of the face
B. Neoadjuvant cemiplimab immunotherapy (anti–PD-L1 antibody), globe sparing orbitotomy, and surgical excision of the mass
Advanced cutaneous SCC with orbital involvement has historically been difficult to treat with 10-year survival rates less than 20%.1 The standard treatment is exenteration, due to difficulty in obtaining clear margins in the orbit. Exenteration has been shown to provide better local control with clear margins obtained in 42.5% to 97% of cases and lower rates of local recurrence with overall survival of 83% and 65% at 1 and 5 years, respectively.2 However, recently, the overall survival benefit of exenteration vs conservative surgeries has been questioned.2- 4 In addition, exenteration causes facial disfigurement, loss of vision, psychological distress, and some, like this patient, may decline this surgery.