The most important conceptual evolution today is represented by the integration of skin surgery with immunotherapy, targeted therapy and radiotherapy,a multimodal and multidisciplinary approach, particularly suitable to high-risk or locally advanced NMSC. The literature is increasingly reporting Mohs and other margin-controlled techniques as one component of an integrated multidisciplinary treatment pathway, rather than an isolated surgical procedure.
The updated 2026 European interdisciplinary guideline for invasive cutaneous SCC reinforces this multidisciplinary approach and the active role of the modern Dermatologic Surgeon within a multidisciplinary tumor board, aiming at tailoring the optimal sequence of surgery, systemic therapy and radiotherapy for each patient’s tumor.
To accomplish this task, an important practical development is also the availability of better identification tools of patients who require staging and surveillance imaging.
A 2026 JAMA Dermatology consensus recommends imaging particularly for cSCCs with substantial metastatic risk—for example, bone invasion, extension beyond subcutaneous fat, large-caliber perineural invasion or tumors ≥4 cm.