How would a low tumor mutational burden (<10) influence your decision to offer neoadjuvant immunotherapy for cutaneous squamous cell carcinoma?

I do not think TMB is a perfect biomarker to predict response to checkpoint inhibition. Having said that, we certainly can't ignore it. For patients with head and neck CSCC, I prefer using neoadjuvant immunotherapy without checking for biomarker/TMB status, as these are usually sun-damaged, inflamma...

TMB is not an accepted biomarker yet for predicting immunotherapy response in cSCC. If you want to use predictive molecular testing, you can consider using Tempus’s Immune Profile Score (IPS) offered as part of their NGS testing platform. The IPS score is based on a set of genes generated with an AI...

I usually do not test TMB for patients with melanoma. I treat all patients with immunotherapy as the first-line option.

There might be some subtleties of what immunotherapy agent(s) to choose, depending on the patient and/or melanoma characteristics.