Skin cancer guidelines released by the AAD in January 2018 and published in the Journal of the American Academy of Dermatology point to the dramatic rise in basal cell and squamous cell (nonmelanoma) skin cancers — as well as the importance of early detection and treatment, and the best ways to prevent these cancers. Nonmelanoma skin cancer currently affects about 3.3 million Americans each year, according to the American Cancer Society (ACS). The ACS attributes this rise to better screening, more sun exposure, and increased life spans. “The good news is that if basal cell or squamous cell cancers are found when very small, they are both very treatable, safely and easily, in an office setting with no scarring,” says Murad Alam, MD, cochair of the Academy’s guidelines committee and vice chair of the department of dermatology at Northwestern Medicine in Chicago. The guidelines largely focus on treatment of “simpler lesions,” according to Dr. Alam. Among the recommendations in the guidelines:
Surgery should be the mainstay of treatment for these cancers, performed by a board-certified dermatologist. The location and size of the cancer will determine the best treatment strategy. A simple excision, Mohs surgery, or curettage and electrodessication may be used. Mohs surgery has a 99 percent cure rate for skin cancers that haven’t been treated before, according to the Skin Cancer Foundation.“Radiation in the treatment of skin cancer is a controversial area,” says Alam, adding that it is “definitely not first line.” One place where it might be an option is for “very elderly patients.”“Above the neck, Mohs surgery has the highest cure rate,” says David J. Leffell, MD, chief of dermatologic surgery and cutaneous oncology at Yale University School of Medicine in New Haven, Connecticut. “Below the neck, proper scraping, burning, and excision” are more commonly used, he added. Dr. Leffell also urges patients to come in if they have a nonhealing sore on their skin, something that is relatively minor if diagnosed earlier.The panel also recommends that people get a full-body skin exam each year by a board-certified dermatologist, which is especially important for patients who have already had nonmelanoma skin cancer. Avoiding midday sun exposure, wearing protective clothing, and using a broad-spectrum, water-resistant sunscreen with at least a 30 SPF rating is also recommended.Everyone should also perform regular skin self-exams to detect skin cancer early, when it is most treatable. If a new or growing spot is identified, or if it is changing, itching, or bleeding, they should make an appointment with a dermatologist.
Omitted from the guidelines was treatment with laser therapy or electronic brachytherapy, which the guidelines panel felt did not have sufficient evidence. Although the bulk of the guidelines address local skin cancers, the panel drew attention to new treatments on the horizon for life-threatening, advanced basal cell cancers, which cannot be treated with surgery alone. PD-L1 inhibitors have been used to treat melanoma and non-small-cell lung cancer, and have been shown to be effective in treating some patients with both basal cell cancer and squamous cell cancer. In September 2018, the U.S. Food and Drug Administration (FDA) approved the use of a drug called Libtayo, which targets the PD-1 pathway, for treatment in patients with metastatic cutaneous squamous cell carcinoma. Additional reporting by Jessica Migala.
