PracticalDermatology

More people are diagnosed with skin cancer each year in the US than all other cancers combined, according to the Skin Cancer Foundation, but dermatologists are making great strides in terms of prevention, early diagnosis and treatment of these cancers. Desiree Ratner, MD, director of the Comprehensive Skin Cancer Center, Mount Sinai Downtown, and Professor of Dermatology, Icahn School of Medicine at Mount Sinai, gives us the scoop on some of the bigger wins in the war on non-melanoma skin cancer.

What’s new and exciting in the treatment of basal cell skin cancer?

Desiree Ratner, MD: There are now two oral treatments for advanced basal cell carcinoma— vismodegib (Erivedge, Genentech), which was FDA approved in 2012, and sonidegib (Odomzo, Sun Pharma), which was FDA approved in 2015. These drugs are indicated for large or difficult-to-treat basal cell cancers that aren’t resectable. We can shrink the cancers so that surgery is an option or use these drugs for long-term management to control tumor growth.

Both medications show local disease control rates of approximately 80 percent, which can translate into dramatic shrinkage in large tumors. The drugs are similar in efficacy and mode of action. Sonidegib is FDA approved for locally advanced basal cell carcinoma that can’t be cured with surgery or radiation, and vismodegib is FDA approved to treat both locally advanced and metastatic basal cell carcinoma.

What about squamous cell carcinoma?

Dr. Ratner: We are now in a position to treat aggressive squamous cell disease with programmed cell death protein 1 (PD-1) inhibitors. There are two PD-1 blockers—nivolumab (Opdivo, Bristol-Myers Squibb) and pembrolizumab (Keytruda, Merck)—approved for melanoma. We have now started to use them for locally advanced or aggressive squamous cell cancer. There have been promising results published in the literature to support this use.

And Merkel cell carcinoma?

Dr. Ratner: Merkel cell carcinoma is a very aggressive skin cancer, and there is now an FDA approved drug—a programmed cell death ligand 1 (PD-L1) inhibitor called avelumab (Bavencio, EMD Serono)—for that as well. It’s the first FDA approved systemic therapy for that tumor, and that’s kind of a big deal.

What are some other wins in terms of skin cancer prevention?

Dr. Ratner: We are seeing summer camps send home permission slips so that staff can put sunscreen on kids, and playgrounds today are more likely to have shade structures so kids are shielded from the sun. We did not see this years ago.