Table I.

Talimogene laherparepvec treatment for the patient’s left forearm squamous cell carcinoma lesions that occurred every 2 weeks for a period of 15 months

T-VEC Treatment number	Days from T-VEC initiation	T-VEC Dose (pfu/mL)	Number of sites	Notable progress
1	0	106	6	CT of left upper extremity with contrast without evidence for nodal or distant disease.
2	21	108	5
3	35	108	5	Erythema surrounding largest lesion improved.
4	49	108	5	Largest lesion with ulceration measuring 4.5 cm longest axis and 0.7 cm deep. Surrounding erythema has nearly resolved.
5	63	108	5	Whole body PET CT imaging without evidence for nodal or distant disease.
6	77	108	5
7	91	108	4	Repeat CT of left upper extremity with contrast without evidence for distant disease. Swelling and induration surrounding forearm ulceration has been stable and is mild. Patient labs
8	105	108	3	Noted new friability of a lesion.
9	119	108	3
10	133	108	3
11	147	108	3	Largest lesion with ulceration measuring 5.5 cm in longest axis. Friability present in second lesion measuring 1.8 cm.
12	161	108	2	Repeat whole body PET CT imaging without evidence for nodal or distant disease.
13	175	108	3	Lesions continuing to fill in and contract. One lesion resolved.
14	189	108	4	Lesions noted to have blood oozing.
15	203	108	4
16	217	108	4
17	231	108	3	Due to resistance to treatment, one lesion was excised.
18	245	108	6
19	259	108	4	Repeat whole body PET CT revealed slightly decreased activity of left forearm lesions and no distant disease.
20	273	108	3	Significant clinical response to treatment and no new definitive lesions.
21	287	108	3
22	301	108	3
23	322	108	2
24	336	108	2
25	350	108	3
26	364	108	3	Repeat whole body PET CT showed new focus of hypermetabolic activity ulnar aspect of left forearm suspicious for disease recurrence.
27	378	108	2	Fine needle aspiration of left arm nodule performed and was nondiagnostic. Continued with treating the site as another focus of SCC.
28	399	108	2
29	413	108	2	One evident remaining lesion has completely filled in and re-epithelialized. Subcutaneous ulnar lesion stable in size.
30	427	108	2
31	441	108	2	Repeat fine needle aspiration of arm lesion revealed SCC.
32	455	108	2	Subcutaneous nodule grew, now measuring 2.5 cm. Repeat whole body PET CT showed increasing hypermetabolic activity in soft tissues of left arm, concerning for SCC recurrence.