@gingerw - There could be several reasons why your doctor is not recommending a pharmaceutical or biological for treatment of your SCC. They may lack familiarity or experience or it is possible that your case is not a good fit for these regimens. Would you feel comfortable in asking your doctor why they are not recommending these alternatives? Have you thought about seeking a second opinion about alternative approaches?

Standard treatments for squamous cell carcinoma (SCC), particularly cutaneous SCC (cSCC), depend on stage and patient factors. For localized SCC, surgery (excision or Mohs surgery) is common, while radiation suits non-surgical cases or high-risk tumors. Immunotherapy, like cemiplimab, a PD-1 inhibitor, is used for advanced or metastatic cSCC when surgery or radiation isn’t viable. Cemiplimab, administered intravenously every 3 weeks, blocks PD-1 to boost immune response, achieving ~47% response rates in trials (e.g., EMPOWER-CSCC-1) with durable outcomes. Side effects include fatigue, rash, and immune-related issues (e.g., pneumonitis). Pembrolizumab, another PD-1 inhibitor, offers similar benefits. Chemotherapy (e.g., cisplatin, 5-fluorouracil (5FU)) is less common, used for metastatic cases or post-immunotherapy failure, often with radiation for palliative care. It's interesting to note that when I was undergoing chemo for colon cancer a common drug is Capecitibine which is a prodrug of 5FU ie, once in the body it breaks down into three forms of 5FU. Well I have been dealing with many precancerous lesions on my face around my eyes and during the chemo with Capecitibine, all of these even those that were not visible lit up! And eventually healed into smooth normal skin. This was such a surprising instance that dermatologist at Mayo use this is a case study for training in medical school. So sometimes drugs work and unexpected ways

Targeted therapies, like EGFR inhibitors (e.g., cetuximab), address specific SCC profiles, typically in advanced head and neck cases. For superficial SCC, cryotherapy or topical treatments (e.g., 5-fluorouracil, imiquimod) are effective. Cemiplimab is ideal for unresectable tumors or immunocompromised patients but requires monitoring for toxicities. Emerging trials explore combination therapies. For deeper details on cemiplimab or recent advances, let me know! Your determined approach will pay dividends!