Patients can pick from a growing array of treatments, from same-day- results surgery to game-changing immunotherapy, to fight the most common type of cancer.
As novel drugs emerge and surgical procedures are refined, treatment options continue to expand for people with the most common cancer type, diseases of the skin.
In an interview with CURE®, Dr. Jeremy Brauer, a dermatologist at NYU Langone Health in New York City and a spokesperson for the Skin Cancer Foundation, reviewed the latest strategies for treating these cancers, which include squamous cell and basal cell carcinomas, as well as the less common but more aggressive melanoma.
CURE®: What surgical strategies are used to treat skin cancers?
Brauer: The intervention with the highest cure rate for surgical procedures is Mohs micrographic surgery. This is ideal for nonmelanoma skin cancers specifically, but there also is growing interest and use in certain melanomas, depending on the skin cancer and its location.
(Tissue is removed and tested a little at a time until the area being treated is free of cancerous cells).
There’s no leaving the office and waiting a week for your results; everything is done on-site in real-time. We process the tissue, and a Mohs surgeon also functions as the pathologist to read the slides and map out where the tumor is or isn’t. The benefit of this is that it allows for tissue conservation, (especially on) the tip of the nose and ears. Also, it has a higher cure rate with the good cosmetic outcome because you are sparing tissue.
Another surgical intervention is a standard excision. You excise, take a big piece of skin and put stitches in, just like you would with Mohs, but it’s not a staged procedure. In general, it’s just one procedure.
Could you describe some of the nonsurgical therapies?
Nonsurgical treatments include electrodesiccation and curettage. These tend to be reserved for individuals who have a superficial basal cell carcinoma or what we call in situ squamous cell carcinoma, where the lesion is very superficial and on the uppermost part of the skin. Here, we use a sharp tool called a curette to scrape the area of involvement, but we also use electrodesiccation to burn the surrounding skin. This is often repeated in series a few times to remove the majority, if not all, of the tumor.
The goal here is to avoid having to cut and sew. The drawback is that you can’t evaluate the tissue under the microscope because you’re scraping and burning the remaining tumor cells.
Another nonsurgical option is radiation therapy. This is sometimes used in conjunction with surgical treatment if it is determined that the subtype of skin cancer warrants it.
If involvement of the nerves is found during the course of Mohs surgery or when the specimen comes back after incision, we refer the individual to receive concurrent radiation therapy.
Radiation therapy is also good for (skin cancer that is not being treated with surgery). In certain instances, the individual might not able to tolerate (surgery) or declines the procedure. Similarly, certain tumors that don’t heal well may be better candidates for a nonsurgical option.
Which medical options do you consider the most exciting?
I really do believe immunotherapy and targeted therapies for metastatic disease have been game changers. We consider immunotherapy an option for melanoma. It’s been a game changer for ... survival in advanced cancers. That has definitely prolonged life for many individuals who unfortunately otherwise would not have fared as well.
Another interesting and promising area is targeted therapy. Here, we’re looking at the identification within the tumor of a mutation, specifically in a gene or pathway, and then targeting that gene or pathway (with medication). This has also led to increased survival rates and really allowed for a change in the way we approach some of the more advanced tumors.
That said, early intervention is key. Once we’ve detected these skin cancers, early intervention results in very high cure rates and, hopefully, prevents some of these local tumors from becoming metastatic or advanced.
What is on the horizon for patients with skin cancer?
Patients can be encouraged by the fact that medicine, technology and innovation are all moving at a very fast pace. More immunotherapy and targeted therapies will be made available to individuals with metastatic melanoma and advanced squamous cell carcinoma.
Also, right now, a biopsy is invasive. There is numbing and taking a blade to the skin. But there are other imaging techniques, and as our ability to detect skin cancer becomes better and greater, we’ll begin to see additional noninvasive biopsy techniques.
How can patients become empowered to be their own best advocates when making treatment decisions?
It starts with education. Knowledge is power. A great resource is a board-certified dermatologist, who can discuss in detail the diagnosis and expectations. Also, reputable websites like that of the Skin Cancer Foundation offer information. Within dermatology, the American Academy of Dermatology and other societies can be great resources.
Going back to prevention, people need to understand that skin cancer is serious. You can die from skin cancer. But the good news is that these are preventable tumors and cancers. You have to take action to prevent it.
How do you do that? (It takes) appropriate use of UVA- or UVB-spectrum sunscreen, sun-protected behaviors when outdoors and screening, not just seeing a dermatologist once a year but also doing monthly self-skin examinations. Look for something new, unusual or changing and bring that to the attention of a dermatologist. Early detection results in early intervention, which results in very high cure rates.