An update on local and systemic therapies for nonmelanoma skin cancer

ABSTRACT

Introduction

Nonmelanoma skin cancers (NMSC) as a group exceed the incidence of all other malignancies combined. NMSC includes basal cell carcinoma, squamous cell carcinoma, and Merkel cell carcinoma. As the incidence continues to rise, it is important to appreciate the available treatment options.

Areas covered

This article discusses the treatment of NMSC through surgical, topical, regional, and systemic modalities.

Expert opinion

As there are many treatment options available for these diseases, selection of the appropriate method can be difficult. With time, we expect treatment decisions to become even more complex and personalized. The role of systemic immunotherapies and neoadjuvant therapies in the treatment of NMSC is still not well defined. Local treatment with intralesional injections and isolated limb infusion may prove to be promising alternative therapies.

KEYWORDS:

• Basal cell carcinoma
• cutaneous malignancies
• local therapy
• Merkel cell carcinoma
• nonmelanoma skin cancer
• regional therapy
• Skin cancer
• squamous cell carcinoma
• systemic therapy

Article highlights

• BCC is stratified as local low-risk, local high-risk, and regional or distant metastatic disease.

• Primary treatment of low-risk BCC includes electrodessication and curettage and surgical excision, while it includes Mohs or surgical excision in high-risk disease.

• SCC is stratified by local low-, intermediate-, high-, and very high-risk, and regional or distant metastatic disease.

• Local low-risk SCC is primarily treated by electrodessication and curettage, surgical excision, or Mohs, while local high- and very-high risk SCC is primarily treated with Mohs/PDEMA or surgical excision.

• Initial treatment of MCC is dictated by regional nodal involvement and the presence of metastatic disease and is stratified as local MCC, regional MCC, and disseminated MCC.

• Treatment of local MCC entails surgical excision with sentinel lymph node biopsy and consideration of adjuvant radiation and systemic therapy, while regional MCC is treated with surgical excision and consideration of lymph node dissection and/or RT with the addition of adjuvant systemic and, in some cases, neoadjuvant therapy.

Declaration of interest

JS Zager has advisory board relationships with and has received fees from Merck, Novartis, Philogen, Castle Biosciences, Pfizer, and Sun Pharma. He also received research funding from Amgen, Delcath Systems, Philogen, Provectus, and Novartis. He serves on the medical advisory board for Delcath Systems. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

The author(s) reported there is no funding associated with the work featured in this article.