Live Blog: Advances in Non-Melanoma Skin Cancer Treatments – Faculty: Scott Dinehart, MD
In this live blog from the Annual Summer SDPA Conference in Las Vegas, Scott Dinehart, MD, presented a lecture on “Advances in non-melanoma skin cancer treatments.” Here are some of the highlights.
Dr. Dinehart began his lecture with a couple of staggering facts. There are more tanning salons in the US than there are McDonalds and Starbucks combined. It’s no surprise then that there is an epidemic of nonmelanoma skin cancer in this country. While many other cancers are decreasing in incident rates, NMSC is increasing, doubling in the last 17 years. We will continue to treat these patients in our practices and clinics, and expanding our knowledge of new and neat treatments will serve this growing population.
“We have a lot of different tools to choose from,” explained Dr. Dinehart. “It’s not all apples: it’s apples and oranges. You have to pick out the best treatment for the individual patient.” Providers should look to the type, size, location, and health condition of the patients as they consider which treatment path to take.
Dr. Dinehart added that we should try to be cost effective. For patients older than 85, sometimes the best and most cost effective choice is to observe the tumor instead of treating it.
If treatment is the best path to take, Dr. Dinehart recommends several nonsurgical options that are becoming increasingly popular including topical chemotherapy, hedgehog pathway inhibitors, and radiation.
Topical chemotherapy can be used for multiple widespread tumors and cosmesis is generally superior to conventional surgery. If the patient has an intense reaction, they will tend to have a higher tumor clearance rate. Dr. Dinehart offered, “You can give a patient a certificate when they complete a difficult course of therapy. They hold on to it.”
Some patients will be good candidates for radiation. This is especially beneficial for patients that are not good surgical candidates, typically geriatric patients. The advantages are seen in the minimal side effects and favorable cosmetic results. Keep in mind that this therapy would not be helpful for patients that are younger because of the potential radiation effects. Radiation also tends to be costly.
On the forefront of treatment options, are the Hedgehog Pathway Inhibitors. These work by inhibiting the pathway that causes the basal cancer cells to grow when inappropriately activated. This can be used as first-line treatment or used before surgery. Patients that come in with tumors which are too large to extract benefit from this therapy. The tumor tends to respond and shrink to a size that is more appropriate for excision. The disadvantages of this treatment are the muscle cramps, hair loss, and taste abnormalities. The cramps tend to be the most concerning.
Dr. Dinehart concluded, “There is a lot of research going on. Your success depends upon proper selection and familiarity with the treatment.” With continued education on the advances in the field, we will confidently choose the most appropriate treatments for our NMSC patients.
Image: Moyan Brenn