Have you considered intralesional cempilumab for locally advanced NMSC/KCs prior to surgery?  

Similar to IL MTX or 5-FU, cempilumab would be a great tool in the arsenal to use as an alternative treatment for patients with skin cancers who are not surgical candidates or who would benefit from neoadjuvant treatment prior to surgery to decrease morbidity. We currently use systemic cempilumab an...

There is an active clinical trial, NCT03889912 using IL-cemiplimab prior to surgery. Otherwise, nearly impossible to get covered. More importantly, have considered systemic neoadjuvant immunotherapy for large cutaneous SCCS prior to surgery.