What are the current treatment approaches for non-melanoma skin cancer? Expert Dr. Barbara Ma provides an overview of the types of therapy and explains how testing, like blood tests and imaging, can impact treatment options.
Dr. Barbara Ma, is Cutaneous Oncologist and an Assistant Professor of Medicine at Weill Cornell Medicine and an Assistant Attending Physician at New York Presbyterian Hospital. Learn more about Dr. Ma.
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Transcript
Jamie Forward:
Dr. Ma, what are the most common treatments for non-melanoma skin cancer?
Dr. Barbara Ma:
Sure. So, for the most common treatments for non-melanoma skin cancers, there are different tools in the toolbox for dermatology, radiation, oncology, and also medical oncology. It’s a very multi-disciplinary treatment plan, usually. So, for the early stages, most of the time, dermatology is able to take care of it with essentially cutting out and making sure they have negative margins. If it is in a more cosmetically sensitive area or a harder to treat surgical area, then that’s where they will loop in the radiation oncologist to do radiation. So, for example, if it’s perhaps like something near the nose or the eye area.
That would be harder to surgically get margins, and that’s where radiation would probably be a part of that treatment plan. And then, me as the medical oncologist, one of the most common tools that we use if needed is the immunotherapy, or the IV medication where it’s an infusion that really activates the immune system to kill the cancer cells. Usually, that is a more commonly used treatment if it’s something that is a non-melanoma skin cancer that has spread to lymph nodes or, again, something that’s come back despite prior surgery radiation.
Jamie Forward:
Okay, so, the immunotherapy is more for advanced disease?
Dr. Barbara Ma:
Yeah. There are more studies in using it in the neoadjuvant setting. Which means, if there’s a surgery, that would be a very heavy or a morbid surgery. Then there is also a role for immunotherapy to shrink it down and maybe avoid surgery completely.
But those tend to be for a really big lesion that that surgeon usually would ask the medical oncologist to evaluate if there’s a role for that. But for the majority of the skin cancers of basal or squamous, if they’re caught very early and are very small, the majority of the time, then dermatology can usually take care of it.
Jamie Forward:
Okay, great. So, how do test results guide treatment and care? Do they have an impact?
Dr. Barbara Ma:
So, we do use the regular bloodwork. Just to make sure that your kidney function is good, your liver function is good, and your blood counts are all good. But for the localized lesions, the dermatologist will use that essentially just to make sure that you’ll tolerate an excision pretty well. For the oncologists, we do use the imaging – meaning the CAT scans or the chest and pelvis – assessing for any lymph node involvement.
We look at those to essentially just get a sense of a baseline of how we measure response, for example, to immunotherapy. And then, for the basic lab work, we’re essentially just looking for ability to tolerate immunotherapy. So, the immunotherapy, again, it activates the immune system. So, if you have any preexisting autoimmune things, those have a potential to flare. So, that’s why sometimes as part of the lab work, if you have, for example, lupus or something like that, then that may be some of the things we check to just try to avoid a flare.