The high response rate may be attributed to patient selection for immunotherapy at our medical center (with only 12% having distant metastasis) or may be due to our reliance on clinical assessment that may overestimate the treatment benefit.19 The high response rate in our cohort aligns with a real-world study performed in Israel showing a response rate of 80% among patients with cSCC treated with PD-1 blockade.20 Here, PDCD1 is linked to skin squamous cell carcinoma.