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Immunosuppression, both iatrogenic and disease-related, is associated with a greatly increased incidence of cutaneous SCC (cSCC) and with aggressive cSCC and worse disease outcomes. Consequently, rapid access to skin cancer services and prudent surgical choices, such as circumferential margin assessment, is essential when treating advanced cSCC in an immunosuppressed patient. For high-risk cancers and control of cSCC multiplicity, additional strategies should be actively considered within the multidisciplinary clinical care team. These include minimization or revision of immunosuppressive medications, systemic chemoprevention (including retinoids, nicotinamide, capecitabine) and adjuvant therapies such as radiotherapy. Unfortunately, there is a relative paucity of good evidence for many of these treatments in the immunosuppressed. Systemic treatments for metastatic cSCC are often contraindicated in organ transplant recipients, notably checkpoint inhibitor immunotherapy. There are also toxicity concerns with some conventional chemotherapies and EGFR inhibitors. Until recently, clinical trials have largely excluded immunosuppressed individuals. Development of more effective treatment for advanced cSCC in this high-risk group and prospective clinical trials are now research priorities.

ohs micrographic surgery (MMS) is considered a standard of care treatment modality for nonmelanoma skin cancer (NMSC) of the head and neck. However, access to dermatologic care and MMS may be limited by wait times, cost, and the relative shortage of dermatologists in rural areas. 1 Insurance type is associated with increased stage at presentation, differences in treatment, and delays in care for patients with melanoma 2-4 and other noncutaneous cancers, including lung, prostate, breast, and colon cancer. [5][6][7][8][9][10] The objective of this study was to assess whether tumor and treatment characteristics differ based on insurance type among patients undergoing MMS for NMSC because there has been little research investigating this association.

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