When would you offer neoadjuvant immunotherapy prior to Mohs surgery in a locally advanced squamous cell carcinoma for which clearance may require enucleation?  

I would flip this question around and answer that radiotherapy is often a terrific option around the eyes, and it should always be considered in this area, especially when a radical surgical procedure is being entertained. Between en face therapy with a shield (superficial, electrons) and IMRT/VMAT...

The potential loss of an eye involves major decision-making and pre-planning with a team. I remember as a fellow working with @Gary D. Monheit at The Eye Foundation Hospital Foundation in Birmingham, hospital bylaws required the surgeon to wake a patient and get permission if a Mohs case got to the ...

Since the question is about immunotherapy, my answer is yes. I would start on cemiplimab neoadjuvant for at least 2 cycles, but I prefer 4 cycles prior to surgery to deepen the response. Many patients will not need surgery afterwards, as the cemiplimab can cure a significant percentage of these pati...