Fig 1.

Metastatic cutaneous squamous cell carcinoma before and after treatment with talimogene laherparepvec (TVEC). A, Clinical photograph before treatment with TVEC. Yellow dashed circle indicates the area of palpable lymph nodes, and periauricular ulceration with erosion of cartilage is visible. B, Yellow arrows indicate pretreatment location of positron emission tomography (PET)-avid lymph nodes. C, PET scan about 6 months after last TVEC dose indicates continued clearance of the neck nodes (no avid neck lesions). D, Clinical photograph taken about 6 months after the last injection of TVEC. Black arrows indicate areas of scout punch biopsies which showed no CSCC. Blue arrows indicate areas of granulation tissue filling in areas of prior deeper defect without clinical recurrence.