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Immunotherapy for Advanced Basal or Squamous Cell Skin Cancers

Immunotherapy is the use of medicines to stimulate a person’s own immune system to recognize and destroy cancer cells more effectively. Some types of immunotherapy can be used to treat people with advanced basal cell carcinoma (BCC) or squamous cell carcinoma (SCC) of the skin.

Immune checkpoint inhibitors

An important part of the immune system is its ability to keep itself from attacking normal cells in the body. To do this, it uses “checkpoint” proteins on immune cells, which act like switches that need to be turned on (or off) to start an immune response.

Cancer cells sometimes use these checkpoints to avoid being attacked by the immune system. But drugs that target checkpoint proteins, called checkpoint inhibitors, can help the immune system find and attack cancer cells.

PD-1 inhibitors

Cemiplimab (Libtayo) and pembrolizumab (Keytruda) are drugs that target PD-1, a checkpoint protein on immune cells called T cells that normally helps keep these cells from attacking other cells in the body. By blocking PD-1, these drugs can boost the immune response against cancer cells.

These drugs are given as an intravenous (IV) infusion, typically every 3 to 6 weeks.

These drugs haven't been studied in people with weakened immune systems, such as people who take medicines for autoimmune diseases or who have had an organ transplant, so the balance between benefits and risks in these people isn’t clear.

For squamous cell skin cancer

Cemiplimab or pembrolizumab can be used to treat people with advanced SCC that cannot be cured with surgery or radiation therapy.

For basal cell skin cancer

Cemiplimab can be used to treat advanced BCC in people who are no longer being helped by (or cannot take) targeted drugs called hedgehog pathway inhibitors.

Possible side effects

Common side effects of checkpoint inhibitors can include:

  • Feeling tired
  • Diarrhea
  • Skin rash
  • Nausea
  • Constipation
  • Bone or joint pain
  • Loss of appetite

Other, more serious side effects occur less often.

Infusion reactions: Some people might have an infusion reaction while getting one of these drugs. This is like an allergic reaction, and can include fever, chills, flushing of the face, rash, itchy skin, wheezing, and trouble breathing.

Autoimmune reactions: These drugs work by basically removing one of the safeguards on the body’s immune system. Sometimes the immune system starts attacking other parts of the body, which can cause serious or even life-threatening problems in the lungs, intestines, liver, hormone-making glands, kidneys, or other organs.

It’s very important to report any new side effects to your health care team right away. If serious side effects do occur, treatment may need to be stopped and you may get high doses of corticosteroids to suppress your immune system.

To learn more about this type of treatment, see Immune Checkpoint Inhibitors to Treat Cancer.

More information about immunotherapy

To learn more about how drugs that work on the immune system are used to treat cancer, see Cancer Immunotherapy.

To learn about some of the side effects listed here and how to manage them, see Managing Cancer-related Side Effects.

The American Cancer Society medical and editorial content team

Our team is made up of doctors and oncology certified nurses with deep knowledge of cancer care as well as editors and translators with extensive experience in medical writing.

Christensen SR, Wilson LD, Leffell DJ. Chapter 90: Cancer of the Skin. In: DeVita VT, Lawrence TS, Rosenberg SA, eds. DeVita, Hellman, and Rosenberg’s Cancer: Principles and Practice of Oncology. 11th ed. Philadelphia, Pa: Lippincott Williams & Wilkins; 2019.

Martins RG. Systemic treatment of advanced basal cell and cutaneous squamous cell carcinomas not amenable to local therapies. UpToDate. 2023. Accessed at https://www.uptodate.com/contents/systemic-treatment-of-advanced-basal-cell-and-cutaneous-squamous-cell-carcinomas-not-amenable-to-local-therapies on August 30, 2023.

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Basal Cell Skin Cancer. Version 1.2023. Accessed at https://www.nccn.org/professionals/physician_gls/PDF/nmsc.pdf on August 30, 2023.

National Comprehensive Cancer Network (NCCN). Practice Guidelines in Oncology: Squamous Cell Skin Cancer. Version 1.2023. Accessed at https://www.nccn.org/professionals/physician_gls/pdf/squamous.pdf on August 30, 2023.

Xu YG, Aylward JL, Swanson AM, et al. Chapter 67: Nonmelanoma Skin Cancers. In: Niederhuber JE, Armitage JO, Doroshow JH, Kastan MB, Tepper JE, eds. Abeloff’s Clinical Oncology. 6th ed. Philadelphia, Pa: Elsevier; 2020.

Last Revised: October 31, 2023

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