Abstract
Squamous cell cancers are responsible for 1 in 5 cancer deaths and survival improvements lag behind those seen in adenocarcinomas. This disparity is in large part due to the limited impact of immunotherapy due to therapeutic resistance, where less than ten percent of patients respond in early stage squamous cell carcinomas of the Head and Neck. Mechanisms that govern intrinsic resistance remain poorly understood and likely arise during the premalignant or dysplastic state. Here, we generated a dataset of murine and human oral squamous epithelia spanning the earliest premalignant stages through invasive carcinoma. Integrative analysis of single-cell and spatial transcriptomics data across the dysplasia to carcinoma continuum reveals early and sustained shifts in epithelial transcriptomes. Spatially informed cell-cell interaction analysis reveals dysplasia-specific upregulation of wound healing and immune remodeling programs in severe dysplasia and invasive carcinoma in a human sample of oral dysplasia. The presence of these transcriptomic programs within early dysplasia may account for the aggressive clinical presentations of squamous cancers including intrinsic therapeutic resistance.