The role of systemic chemotherapy with cytotoxic agents in squamous cell carcinoma of the skin remains uncertain. A number of agents in combination have been reported to induce high rates of remission, either alone or as a component of a multidisciplinary management plan. Fragmentary data suggest that the most benefit is achieved when chemotherapy is applied to patients with advanced local disease not easily treated with surgery either due to location (eg, on the face) or comorbidity. Concurrent chemoradiation has been recommended for the control of extensive lymph node involvement as a result of experience derived from similar studies in patients with squamous cell carcinomas of the head and neck, cervix, and anus. No standard treatment of metastatic disease has been formulated, although combinations of cisplatin with 5-fluorouracil (5-FU), doxorubicin, or bleomycin have demonstrated some degree of efficacy, achieving complete responses (CRs) in some cases. Clearly, the relative rarity of patients with high-risk, potentially fatal, squamous cell carcinoma of the skin has limited prospective efforts to define ideal management. As our awareness of the increasing numbers of such problem patients becomes clear, hopefully more efforts will be forthcoming.
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