Trends in the Management of Non-Melanoma Skin Cancers

Various trends in the prevention and treatment of non-melanoma skin cancer-from new chemoprevention agents to the role of telemedicine-were highlighted in a recent review published in the journal Current Opinion in Pharmacology.

“Many of these trends have the potential to make a big impact,” said Mackenzie Wehner, MD, MPhil, a clinical instructor and post-doctoral research fellow in dermatology at the University of Pennsylvania, in an interview with Cancer Network. “Improving access to care, treatment of actinic keratoses, sun protection and chemoprevention in high-risk groups, and newer therapies for advanced cancers are all poised to make a big difference.”

Among the most important trends noted in the review are several new or emerging therapies, according to Wehner. “I will be eagerly watching to see new data on medicines for prevention, particularly the over-the-counter nicotinamide, which has shown very promising results in an Australian trial for patients with multiple keratinocyte carcinomas,” she said.

Wehner also noted the value of vismodegib, checkpoint inhibitors, and programmed cell death 1 (PD-1) blockade, which are transforming the treatment of advanced skin cancers. Specifically, vismodegib or radiotherapy is used to treat inoperable basal cell carcinoma. Immune checkpoint inhibitors, such as nivolumab and pembrolizumab, have proven effective in the treatment of inoperable and/or metastatic squamous cell carcinoma. PD-1 blockade with cemiplimab has been demonstrated to be effective in advanced cutaneous squamous cell carcinoma, with clinical response in about 50% of patients.

With regard to prevention, the review highlighted the failure to impact rural populations using conventional media, such as special-interest magazines promoting sun protection. The researchers noted that effective health communication alternatives in this population may include teledermatology and teledermoscopy, as well as smart phone apps or text messages.

Wehner stressed the dangers of indoor tanning, another trend not mentioned in the review. “I also think that limits and bans on indoor tanning will have a big impact, though it may be many decades before we see those results.”

Jerry D. Brewer, MD, MS, a professor of dermatology at the Mayo Clinic in Rochester, Minnesota, said the article does a good job of spreading important messages about non-melanoma skin cancer.

“The field of dermatology is very aware of the trends, and this paper does not have a paradigm-shifting effect on those who are already skin cancer experts. However, it may have an impact on other fields of medicine that are less aware of the health implications associated with non-melanoma skin cancer,” Brewer said in a separate interview with Cancer Network. “The most important thing is that, even though these non-melanoma skin cancers have been traditionally thought of as not a big deal, they can be life threatening and/or debilitating if not treated appropriately.”