Dr. Darrell Rigel Highlights Urgent Skin Cancer Trends at Winter Clinical 2026

Skin cancer continues its upward trajectory, with new data showing that one in 19 Americans will be diagnosed with melanoma in their lifetime. This alarming statistic headlined a wide-ranging presentation by Darrell S. Rigel, MD, MS, at the 2026 Winter Clinical Dermatology Conference in Hawaii, where he delivered a rapid-fire update on key developments in skin cancer prevention, diagnosis, and treatment.

Dr. Rigel emphasized both the expanding burden of skin cancer and the growing tools dermatologists have to combat it.

MELANOMA ON THE RISE

New data in CA: A Cancer Journal for Clinicians reveal that more than 112,000 Americans will be diagnosed with invasive melanoma in 2026, with an additional 122,000 in situ cases. Together, this puts the lifetime risk of any melanoma at 1 in 19—its highest level ever.

“Melanoma is now the fourth most common cancer in men and fifth in women,” Dr. Rigel said. “Despite biologic advances that temporarily reduced death rates, the overall mortality curve is rising again.”

He noted a stark correlation between melanoma mortality and access to dermatologic care. Areas with fewer dermatologists saw significantly higher death rates.

“We can make a difference in mortality by simply being available,” Rigel said.

NEW EVIDENCE FOR PREVENTION: NICOTINAMIDE AND EARLY INTERVENTION

A large study of 34,000 patients confirmed that nicotinamide (vitamin B3) reduces the risk of subsequent skin cancers, especially when started after the first diagnosis.

“The earlier it’s started, the greater the benefit,” Dr. Rigel said, calling the findings “a strong case for proactive prevention.”

SQUAMOUS CELL CARCINOMA: THE GENOMICS ERA

For squamous cell carcinoma (SCC), Dr. Rigel highlighted genomic testing as a game-changer. While current staging models have only 75% concordance and low predictive value, the 40-gene expression profile (40-GEP) test can stratify metastatic risk far more precisely.

“In high-risk patients, the test’s positive predictive value is 50%, versus just 10% in traditional models,” he said.

Genomic data, when added to existing staging systems, improves accuracy and can help guide decisions on adjuvant radiation therapy, particularly for patients in the Class 2B risk category.

A separate study also identified hidradenitis suppurativa (HS) as a previously unrecognized risk factor for SCC metastasis, adding urgency to monitoring in this population.

BASAL CELL CARCINOMA: SIMPLIFIED, EFFECTIVE THERAPIES

Dr. Rigel reviewed new evidence supporting curettage followed by topical imiquimod as a low-recurrence, cosmetically favorable option for treating certain basal cell carcinomas. In one study, 10-year recurrence rates were just 2.5%.

For advanced BCCs, hedgehog inhibitors remain a mainstay, though newer agents like sonidegib appear to cause fewer side effects such as muscle cramps and taste changes. He also flagged the emerging role of cemiplimab in patients who fail hedgehog therapy.

MERKEL CELL CARCINOMA: HOPE WITH IMMUNOTHERAPY

Once considered uniformly fatal in advanced stages, Merkel cell carcinoma (MCC), Dr. Rigel noted, now has a viable treatment option: pembrolizumab.

“This represents a major advance for a rare but deadly cancer,” he said, referencing recent data showing significant survival benefits.

MELANOMA PROGNOSTICS AND GENOMICS: TIME TO PERSONALIZE

Highlighting another leap forward, Dr. Rigel reviewed the expanding use of the 31-gene expression profile (31-GEP) test to predict melanoma outcomes. In a SEER database analysis, the test outperformed traditional prognostic factors and helped stratify even low-risk patients.

Interestingly, patients whose tumors were tested had earlier detection of recurrence and lower tumor burden, likely due to more vigilant follow-up, he said.

Other prognostic findings included:

• Older age remains a powerful independent predictor of recurrence.
• Patients with nevus-associated melanoma (including acral types) tend to have better outcomes than those with de novo disease.
• The Breslow thickness cutoff for low-risk melanomas remains under 0.8 mm, though newer data suggest minor refinements.

AI AND THE FUTURE OF DIAGNOSIS

Artificial intelligence is increasingly accurate in identifying melanoma, with higher sensitivity but lower specificity than dermatologists.

“The best results came when AI was paired with clinician judgment,” Rigel said, noting the growing role of dermoscopy and digital diagnostics in everyday practice.

LOOKING AHEAD

Dr. Rigel concluded by urging dermatologists to embrace genomics and personalized care while advocating for earlier access and routine screening.

“We now have more data, more tools, and more evidence than ever,” he said. “If we use them wisely, we can improve survival and outcomes across the skin cancer spectrum.”