Optimizing High-Risk CSCC Management Through Multidisciplinary Collaboration

It’s a Tuesday morning in Austin, and the Texas sun is already casting long shadows across the limestone facades of downtown. Inside the Dell Seton Medical Center, dermatologist Dr. Elena Vasquez is reviewing a case that’s become all too familiar in recent years: a patient with advanced cutaneous squamous cell carcinoma (CSCC), a form of skin cancer that’s aggressive, often overlooked in its early stages, and increasingly common in sun-drenched regions like Central Texas. The patient isn’t just battling the disease—they’re navigating a fragmented healthcare system where oncologists, surgeons, and radiologists operate in silos, each with their own treatment plans and timelines. The result? Delays, duplicated tests, and, in the worst cases, outcomes that could have been prevented with a more coordinated approach.

This isn’t just an Austin problem. It’s a national one, but the stakes perceive higher here, where the intersection of high UV exposure, an aging population, and a healthcare system stretched thin by rapid growth creates a perfect storm. The latest guidance from dermatology experts—echoed in a recent Dermatology Times analysis—makes one thing clear: for patients with high-risk CSCC, multidisciplinary collaboration isn’t just beneficial; it’s critical to survival. And yet, in cities like Austin, where the healthcare landscape is as diverse as its music scene, achieving that coordination is easier said than done.

The Silent Epidemic Hiding in Plain Sight

Cutaneous squamous cell carcinoma is the second most common form of skin cancer in the U.S., with an estimated 1.8 million cases diagnosed annually. While most cases are caught early and treated with simple excision, a subset—about 5%—becomes advanced, meaning it has spread beyond the skin to lymph nodes or other organs. For these patients, the five-year survival rate drops precipitously, sometimes to as low as 30%. What’s more alarming is that the incidence of advanced CSCC has been rising, particularly in sunbelt states like Texas, where outdoor lifestyles and a cultural aversion to sunscreen collide with a healthcare system that’s still catching up to the demand.

In Austin, the problem is compounded by the city’s rapid growth. The metro area has added over 500,000 residents since 2010, many of them retirees drawn to the Hill Country’s mild winters and outdoor amenities. Older adults are at higher risk for CSCC due to cumulative sun exposure, and when the disease advances, their outcomes often hinge on how quickly and seamlessly their care team can collaborate. Yet, as any Austinite who’s tried to navigate the city’s traffic-clogged roads knows, coordination isn’t exactly the region’s strong suit. The same goes for its healthcare system, where patients often discover themselves shuttling between specialists at the University of Texas at Austin’s Dell Medical School, private oncology practices in the Domain, and radiation centers in Round Rock—each with their own electronic health records, scheduling quirks, and treatment philosophies.

Why Multidisciplinary Care Isn’t Just a Buzzword

The push for multidisciplinary care in oncology isn’t new, but its application to advanced CSCC is gaining urgency. The Dermatology Times piece highlights how this approach can break down logistical barriers that often delay treatment. For example:

• Tumor Boards: Weekly or biweekly meetings where dermatologists, medical oncologists, radiation oncologists, and pathologists review complex cases together. In Austin, institutions like the Livestrong Cancer Institutes at Dell Med have begun adopting this model, but access remains uneven, particularly for patients in rural areas or those relying on safety-net providers like CommUnityCare.
• Shared Decision-Making: Patients with advanced CSCC often face a dizzying array of treatment options—surgery, radiation, immunotherapy, or a combination—each with its own risks and benefits. A multidisciplinary team can present a unified recommendation, reducing the cognitive load on patients who are already overwhelmed.
• Streamlined Referrals: In a fragmented system, a patient might wait weeks for a referral from a dermatologist to an oncologist, only to find that the oncologist’s preferred treatment plan conflicts with the surgeon’s. Multidisciplinary clinics, like those emerging at the Texas Oncology network, aim to collapse these timelines by having all specialists under one roof—or at least in regular communication.

The benefits aren’t just theoretical. A 2023 study published in JAMA Dermatology found that patients with advanced CSCC who received care through a multidisciplinary clinic had a 20% higher likelihood of receiving guideline-concordant treatment and a 15% reduction in time from diagnosis to treatment initiation. For a disease where every week counts, those numbers translate to lives saved.

Austin’s Unique Challenges—and Opportunities

No two cities face the same barriers to coordinated care, and Austin’s quirks produce its challenges distinct. For one, the city’s healthcare ecosystem is a patchwork of academic medical centers, private practices, and safety-net providers, each with different levels of resources and expertise. The Dell Medical School, for instance, is a leader in value-based care and has pioneered some of the most innovative multidisciplinary models in the state. But for patients who see private dermatologists in Westlake or Cedar Park, access to those models isn’t guaranteed.

Then there’s the issue of geography. Austin’s sprawl means that patients in Manor or Pflugerville might have to drive 45 minutes to see a specialist at the central campus, a journey that’s not always feasible for those with advanced disease. Telemedicine has helped bridge some of these gaps, but it’s not a panacea—particularly for a condition like CSCC, where physical exams and biopsies are often necessary.

Culturally, Austin’s emphasis on wellness and prevention could be a double-edged sword. On one hand, the city’s residents are more likely to seek regular skin checks than those in less health-conscious regions. On the other, there’s a pervasive myth that “Texas skin” is tougher—that if you’ve lived here all your life, you’re somehow immune to the sun’s effects. Dermatologists in the area report seeing patients who dismiss early symptoms as “just a bad sunburn” until the cancer has progressed to an advanced stage.

Finally, there’s the elephant in the room: cost. Texas has the highest uninsured rate in the nation, and even for those with insurance, the out-of-pocket costs of advanced CSCC treatment can be staggering. A single course of immunotherapy can run tens of thousands of dollars, and patients often face surprise bills from out-of-network providers. Multidisciplinary care can help mitigate some of these costs by reducing redundant tests and hospitalizations, but for uninsured or underinsured patients, the upfront financial barrier can be insurmountable.

The Role of Local Institutions in Closing the Gap

Despite these challenges, Austin is home to several institutions that are making strides in multidisciplinary CSCC care. The key is knowing where to glance—and what questions to ask.

The Livestrong Cancer Institutes at Dell Medical School

As part of the University of Texas at Austin, the Livestrong Cancer Institutes have become a hub for coordinated oncology care. Their multidisciplinary tumor boards meet weekly to review complex cases, including advanced CSCC, and they’ve developed protocols to ensure that patients see all necessary specialists within a 72-hour window. For Austinites, this means that a diagnosis from a dermatologist at Dell Med can quickly translate into a comprehensive treatment plan without the usual delays. The Institutes also offer financial navigation services to help patients understand their insurance coverage and access assistance programs.

Texas Oncology

With multiple locations across the Austin metro area, Texas Oncology is one of the largest cancer care providers in the region. Their approach to CSCC emphasizes collaboration between dermatologists, surgeons, and medical oncologists, often within the same clinic. For patients, this can signify fewer trips to different facilities and a more cohesive treatment experience. Texas Oncology also participates in clinical trials for advanced CSCC, giving patients access to cutting-edge therapies that might not be available elsewhere.

CommUnityCare Health Centers

For uninsured or underinsured patients, CommUnityCare’s network of clinics provides a critical safety net. While their resources are more limited than those of academic medical centers, they’ve partnered with local oncologists to create referral pathways for patients with suspected advanced CSCC. Their case managers work to connect patients with financial assistance programs, including those offered by pharmaceutical companies for immunotherapy drugs. It’s not a perfect system, but for many Austinites, it’s the difference between receiving care and going without.

What Patients and Caregivers Require to Know

If you or a loved one has been diagnosed with advanced CSCC in the Austin area, the path forward can feel overwhelming. Here’s what to keep in mind:

• Ask About Multidisciplinary Clinics: When meeting with a dermatologist or oncologist, ask whether they participate in a multidisciplinary tumor board or clinic. If they don’t, request a referral to a center that does. In Austin, the Livestrong Cancer Institutes and Texas Oncology are two places to start.
• Push for Timely Referrals: Delays in care can have serious consequences. If you’re waiting more than a week to see a specialist, follow up with your provider and ask if there’s a way to expedite the process. Some clinics, like those at Dell Med, have dedicated patient navigators who can help move things along.
• Explore Financial Assistance: The cost of treatment can be daunting, but there are resources available. The Livestrong Foundation (no relation to the Livestrong Cancer Institutes) offers financial assistance for cancer patients, and many pharmaceutical companies have patient assistance programs for immunotherapy drugs. CommUnityCare’s financial counselors can help uninsured patients explore their options.
• Advocate for Yourself: If your care team isn’t communicating effectively, don’t hesitate to speak up. Ask for a case manager or patient navigator who can help coordinate your care. In Austin, organizations like the Central Texas Cancer Coalition offer support groups and advocacy resources for cancer patients and their families.

Given My Background in Public Health, Here’s Who You Need in Your Corner

Over the years, I’ve seen how the right team can make all the difference for patients navigating complex diagnoses. If advanced CSCC is impacting you or someone you love in Austin, here are the three types of local professionals you’ll want to connect with—and exactly what to look for when choosing them.

1. Multidisciplinary Oncology Navigators

These are the quarterbacks of your care team. They don’t provide treatment themselves but instead work to ensure that all your specialists are on the same page. In Austin, look for navigators who:

• Have experience specifically with skin cancer, not just oncology in general. CSCC has unique treatment pathways, and you want someone who understands the nuances.
• Are affiliated with a major healthcare system, such as Dell Med or Texas Oncology. This ensures they have access to the latest protocols and can facilitate referrals to top specialists.
• Offer financial navigation services. The best navigators don’t just coordinate care—they also help you understand your insurance coverage and connect you with assistance programs.
• Have strong communication skills. You’ll be sharing sensitive information with this person, so it’s key to find someone who listens and explains things clearly. Ask for references from other skin cancer patients if possible.

2. Dermatologic Surgeons with Mohs Expertise

For many patients with advanced CSCC, surgery is the first line of defense. But not all surgeons are created equal. In Austin, prioritize those who:

• Are fellowship-trained in Mohs micrographic surgery, the gold standard for treating high-risk skin cancers. This technique allows for precise removal of cancerous tissue while sparing healthy skin, which is critical for tumors on the face, hands, or other sensitive areas.
• Have experience with complex reconstructions. Advanced CSCC often requires extensive surgery, and you’ll want a surgeon who can not only remove the tumor but also repair the resulting defect with minimal scarring.
• Work closely with medical and radiation oncologists. The best dermatologic surgeons don’t operate in a vacuum—they’re part of a broader care team. Ask whether they participate in tumor boards or have established referral relationships with oncologists in the area.
• Practice at a facility with on-site pathology. This allows for immediate analysis of tissue samples, which can speed up the surgical process and reduce the need for multiple procedures.

3. Radiation Oncologists Specializing in Skin Cancer

Radiation therapy is often used in conjunction with surgery or as a standalone treatment for patients who aren’t surgical candidates. But radiation for CSCC is different from radiation for other cancers, and you’ll want a specialist who:

• Has a track record of treating skin cancers, not just breast, lung, or prostate cancer. The techniques and dosing are different, and experience matters.
• Uses advanced imaging technology, such as CT or MRI, to precisely target tumors while minimizing damage to surrounding tissue. In Austin, look for providers who offer image-guided radiation therapy (IGRT) or intensity-modulated radiation therapy (IMRT).
• Is affiliated with a multidisciplinary clinic. Radiation oncologists who work as part of a larger team are more likely to coordinate with your other providers and adjust treatment plans as needed.
• Offers supportive care services. Radiation can cause side effects like skin irritation, fatigue, and nausea. The best providers offer access to nutritionists, physical therapists, and other specialists who can help manage these symptoms.

The Bottom Line

Advanced CSCC isn’t just a medical challenge—it’s a logistical one. In a city like Austin, where the healthcare system is as dynamic as its music scene, the key to better outcomes lies in breaking down the silos that too often stand between patients and the care they need. Multidisciplinary collaboration isn’t a luxury; it’s a necessity, and the institutions and professionals who embrace it are the ones who will lead the charge in turning the tide against this disease.

For Austinites, the message is clear: if you or a loved one is facing an advanced CSCC diagnosis, don’t settle for fragmented care. Seek out the teams and resources that prioritize coordination, and don’t be afraid to advocate for yourself. The tools to fight this disease are here—we just have to use them wisely.

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