Take 5: Directions in Skin Cancer Care

1. Cryosurgery Found Effective For Cancer of Extremities. With the correct protocol, liquid nitrogen cryosurgery can be safe and effective for advanced and inoperable tumors, a study shows (G Ital Dermatol Venereol.; 146(4): 249-55). The author evaluated 48 patients with 50 advanced squamous cell carcinomas (SCC) of the extremities. They were each treated with open and thick LN spray in two freeze/thaw cycles, reaching a temperature around -50ºC inside the tumor but not less than -20ºC in the tumor limits and underlying structures. The overall cure rate was 88 percent, with follow-up between one and eight years (mean 2.64 years).

2. Imiquimod May Be Beneficial For BCCs. Topical imiquimod 5% Cream (Aldara, Graceway) may be an effective intervention for basal cell carcinoma (J Dermatol Treat 2011 July 24, e-pub). Researchers evaluated three patients with large BCCs successfully treated with imiquimod. Although these cases and those from the literature do not rise to the level of evidence, the researches indicate that imiquimod may be a reliable, efficacious, and safe non-surgical option for selected cases of large superficial BCCs.

3. Lentigo Meligna May Cause Delayed Detection of Melanoma. Increased cases of lentigo meligna on the head and neck may cause delayed detection of melanoma (Dermatol Surg 2011 Jul 25, e-pub). Researchers reviewed histologic and clinical features of melanomas diagnosed in a group over a 10-year period to determine trends in diagnosis and lesion derivation, predictive value of clinical lesion size and effect of physician and patient concerns before biopsy. They found that melanoma biopsies increased significantly more than nevus biopsies and patient visits. Melanomas predominantly (81 percent) arose de novo, with remaining lesions as likely to arise from common as dysplastic nevi. In addition, melanomas were detected at twice the rate, and at earlier stage, in established as in new patients. Delayed detection was associated with location on trunk and extremities, new patient status, patient concern before biopsy, and physician suspicion of nonmelanoma skin cancer.

4. Role of Angiogenesis in Melanoma still Undetermined. A report evaluates angiogenesis as a potentially relevant target for melanoma experimental therapeutics (Ther Adv Med Onc; 2(6): 367-80). Researchers note that a variety of angiogenesis inhibitors are currently being tested in both metastatic and adjuvant melanoma clinical trials. Given promising phase II data for the combination of bevacizumab (a monoclonal antibody targeting vascular endothelial growth factor) with cytotoxic chemotherapy, researchers suggest that larger phase III studies are required to determine the true extent of clinical benefit. These studies may also aid understanding of the mechanism of action of angiogenesis inhibitors.

5. Systemic Approaches Possibly Effective For SCCs. For squamous cell carcinomas not amenable to local cures, a new review showed that systemic interventions may yield benefit (Br J Dermatol. 2011 Jul 20, e-pub). Researchers reviewed 28 observational studies that yielded 119 patients for analysis and found the overall response rate for systemic therapy was 72 percent after nine weeks, with the duration of response averaging 42 weeks. Response rates to specific therapies ranged from 20-100 percent.