The Dermatology-Led Skin Cancer Tumor Board

I want to be honest about how I got here, because it did not start with a vision or a strategic plan. A few years ago, the community hospital where I cover inpatient consultations had a virtual skin cancer tumor board that met periodically and quietly. A nearby community hospital had done something similar but given up on it for a variety of reasons (specialist attendance, case counts etc). I was not running any part of our hospital’s tumor board and was not even referring patients to them—I thought a large academic center was my only option, even though wait times could be long—but the invitation to attend was an open one.

I started attending out of nothing more than pure curiosity and refreshing my National Comprehensive Cancer Network (NCCN) guidelines knowledge through real case studies. I had no role, but I found myself genuinely interested in how advanced cases were being discussed, what the surgical oncologist was thinking, how the medical oncologist was weighing systemic therapy options, and whether the decisions being made reflected the guidelines and updates I was reading in the literature.

I kept showing up. I listened. I asked the occasional question. And somewhere in those months of sitting in a video conference room where I had no official standing, I noticed things: how dermatologic context was informing the discussion, cases where the clinicopathologic nuance that a dermatologist would immediately recognize was affecting the treatment planning conversation. I was not there to take over anything. I was there because I wanted to learn.

I share this because when I was eventually asked to serve as medical director of the tumor board, I almost said no. I did not think of myself as an expert in oncodermatology. I was a clinical dermatologist who happened to be curious. I said yes because an amazing senior dermatologist was ready to retire after starting this tumor board initially and then restarting it following a hiatus. And what I have learned since then has reshaped how I think about our role in melanoma and advanced skin cancer care, and about what we owe the patients in our communities.

THE DERMATOLOGIST’S FIT IN MODERN MANAGEMENT OF SKIN CANCER

The management of melanoma and advanced skin cancer has evolved dramatically over the past decade. Modern treatment now requires coordination across dermatology, surgical oncology, medical oncology, radiation oncology, dermatopathology, radiology, reconstructive surgery, clinical trials and genetics. As immunotherapy, neoadjuvant therapy, molecular profiling, and advanced imaging become increasingly integrated into care pathways, the traditional fragmented model of skin cancer management is no longer sufficient in many cases.

A dedicated multidisciplinary melanoma and skin cancer tumor board offers a better solution particularly within the community hospital setting in regard to patient access. Also, dermatologists are uniquely positioned to lead these programs because they often serve as the first point of diagnosis and the first to help the patient in understanding their skin cancer, along with their role in longitudinal surveillance post treatment and realistically coordinating the timing and locations for procedural and oncologic care.^1,2

Skin cancer remains the most common malignancy in the United States. Melanoma alone accounts for the majority of skin cancer-related deaths, with more than 8,500 annually in the US despite advances in therapy.3

Melanoma incidence has continued to increase over time. Age-adjusted rates for new melanoma of the skin cases rose on average 1.1% each year from 2014 to 2023.3 At the same time, treatment complexity has escalated significantly, often involving:

• Immune checkpoint inhibitor options available on formulary and clinical trials
• BRAF/MEK targeted therapies
• Neoadjuvant immunotherapy strategies^4,5
• Prognostic risk stratification with genetic expression profiling tests6
• Sentinel lymph node algorithms affected by genetic expression profiling tests
• Various imaging surveillance options
• Complex reconstruction and radiation therapy planning
• Older age of skin cancer patients on presentation

These developments require increasingly coordinated multidisciplinary decision-making.

WHY A TUMOR BOARD AND WHEN?

Multidisciplinary tumor boards (MTBs) have consistently demonstrated meaningful effects on oncology decision-making and care coordination across cancer types.7 Many prior publications have reviewed tumor board effectiveness and found that multidisciplinary tumor boards can improve health care decision-making, treatment planning, guideline adherence, and patient care using interdisciplinary coordination.^2,8-10

In skin cancer, specifically, a national survey of multidisciplinary skin cancer conferences found: 2

• 97% of respondents believed tumor boards had a moderate-to-significant impact on patient care
• All respondents reported educational benefit
• 92% stated tumor boards improved physician collaboration

These findings are particularly relevant in advanced skin cancers, where staging accuracy and timing of systemic therapy can directly influence survival outcomes. But just as important is the coordination of care and services. Data increasingly demonstrate that melanoma outcomes improve at experienced, high-volume centers with coordinated multidisciplinary care. Coordination can help replicate many of the organizational advantages seen in high-volume systems.

Dermatologists occupy a unique position in the melanoma and non-melanoma skin cancer care continuum.1 With many malignancies, diagnosis and longitudinal management are separated between specialties; however, dermatologists frequently:

• Detect suspicious lesions
• Perform a large spectrum of types of biopsies (excisional, scouting, punch, incisional)
• Interpret clinicopathologic findings
• Perform Mohs or coordinate surgical and radiation referrals
• Prescribe hedgehog inhibitors
• Have familiarity and/or ability to infuse immunotherapy
• Can administer superficial radiation therapy or brachytherapy
• Inject intralesional chemotherapy
• Conduct lifelong surveillance for recurrence of skin cancers with and without total body photography
• Identify new primary melanomas and other skin cancers
• Manage field cancerization and immunosuppressed patients (chemical peels, laser therapy, photodynamic therapy, prescription creams)

This longitudinal involvement gives dermatologists a systems-level understanding of skin cancer progression and recurrence patterns that can be personalized to the patient’s preference and support system.

Additionally, modern melanoma care to support oncology increasingly intersects with dermatology-driven consultations for management of immune-related cutaneous toxicity as well as dermoscopy and digital surveillance.

MAKEUP OF AN EFFECTIVE SKIN CANCER TUMOR BOARD

Dermatologists should not be peripheral participants in oncology care. If we are interested, we are positioned to be central coordinators of a patient’s care.

An effective melanoma and skin cancer tumor board typically includes:

• Dermatology
• Dermatopathology
• Medical oncology
• Radiation oncology
• Surgical Oncology (Plastics/reconstructive surgery and ENT/head and neck surgery)
• Radiology
• Oncology nursing and navigation
• Genetics and clinical trials teams

Many patients prefer receiving cancer care close to home. Community hospitals offer faster scheduling, reduced travel burden, greater continuity of care, improved physician accessibility, and stronger integration with local primary care networks

As systemic therapies become more standardized and evidence-based, high-quality melanoma care can be supported in the community and does not need to be exclusively delegated to tertiary academic centers.

AN IMPORTANT EVOLUTION IN COMMUNITY ONCOLOGY CARE

A well-organized community tumor board can provide academic-level collaboration closer to home. Evidence-based guidelines are used daily at our community hospitals and we can start taking care of the patient sooner. What is essential is getting the system in place in the community. It is essential that we have the experienced specialists at the table and nursing navigators for coordinating care. Virtual meetings as a vehicle for tumor board coordination can make the old-fashioned in-person tumor board meetings so much more accessible within the community.8

Dermatologist-led melanoma and skin cancer tumor boards represent an important evolution in community oncology care. They strengthen collaboration, improve patient outcomes, elevate institutional expertise, and ensure patients can access sophisticated cancer care within their own communities. The future of skin cancer treatment will depend not only on new therapies but on building systems that coordinate specialists efficiently, collaboratively, and early in the patient journey.¹¹ And the patient journey does not just start and end with treatment. The patient journey is the one the dermatologist walks along with their patient as they detect and hopefully overcome these skin cancers. Let’s start building more tumor boards.

“

Photodynamic therapy remains a highly 
effective field therapy for actinic keratosis 
and offers a combination of high clearance 
rates, excellent cosmetic outcomes, 
and strong patient satisfaction.

”