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Live Blog: Nonmelanoma Skin Cancer: Basal Cell Carcinoma and Squamous Cell Carcinoma – Scott Dinehart, MD

In this live blog from the 12th Annual SDPA conference in Indianapolis, Dr. Scott Dinehart spoke about “Non-Melanoma Skin Cancer: Basal Cell Carcinoma and Squamous Cell Carcinoma.” Here are some of the highlights. 

Dr. Scott Dinehart opened his lecture with some statistics about non-melanoma skin cancer. “There is an epidemic of non-melanoma skin cancer in the United States.  This year over 3.5 million new cases of skin cancer will be diagnosed,” he said, noting that the incidence has doubled in the last 17 years. 

Basal Cell Carcinoma (BCC)

BCC is the most common skin cancer. It occurs most commonly on sun-exposed skin and rarely metastasizes.  It appears pearly, translucent, and shiny but there are some variants.  Sometimes you’ll see superficial basal cell often on the trunks and extremities.  Pigmented basal cell is also pearly or shiny, but pigmented instead of translucent. These lesions can also be very small and identified by a “red dot.”  If you stretch the area around the dot you may see the shine around it.

Squamous Cell Carcinoma (SCC)

Opaque nodule is often seen in immuno-compromised patients. One out of four skin cancer deaths are due to squamous cell carcinoma.  A variant is Keratoacanthoma.  Patients tend to be concerned with these as they come up very rapidly.  However, they are typically easy to treat with a scrape or cut.

Verrucous Carcinoma

Verrucous Carcinoma is often mis-diagnosed as warts.  If you have a patient with a wart that is not getting better then it’s not a bad idea to biopsy it.  If you see destruction then you can be sure it’s wart.  This carcinoma is often HPV induced and requires great communication with your pathologist. 

When do you get a biopsy? 

Dr. Dinehart recommends biopsy if a mark or lesion hasn’t healed in 3-6 weeks, if it’s translucent or pearly, or if it is sore, crusting, or bleeding.

Treatment Options

For treatment options, Dr. Dinehart categorizes both surgical and medical treatment.  When selecting a treatment, providers should look at the type, size, pathology, and anatomic location of the tumor.  It is also recommended to consider the cost and provider’s familiarity with the treatment.  For example, a surgical option is cryosurgery, but would not be selected unless the provider has performed this often and is satisfied with patient outcome. Other surgical treatment options are curettage and electrosurgery, surgical excision, and Mohs micrographic surgery.

When a patient is not a good candidate for surgery, Dr. Dinehart does not hesitate to look at non-surgical treatment options. While expensive, radiation is an option with minimal side effects, favorable cosmetic results, and good cure rate. This treatment does require the patient to come in 5 times a week for 4-6 weeks, making it less popular for professionals. Other good options are Hedgehog Pathway Inhibitors and Imiquimod. 

Imiquimod is approved for superficial basal carcinoma. You can get a good cure for BCC and it can also be used for SCC.  For patients with cosmetic concerns, this is a good treatment. Widespread tumors often respond well to Imiquimod. Dr. Dinehart tends to treat his patients with a once-a-day regimen, reflecting that, “the more intense inflammatory reactions were associated with higher tumor clearance rates.”

He reminded the audience that the goal is to be able to guide the patient to a treatment that is best for them. 

Image: Stephanie Young Merzel