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Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

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Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers from Patient Empowerment Network on Vimeo.

What should non-melanoma skin cancer patients know about immunotherapy? Expert Dr. Silvina Pugliese explains common situations when immunotherapy is used and updates about immunotherapy treatment and research.

Silvina Pugliese, M.D., is a Clinical Assistant Professor of Dermatology and Attending Physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute. Learn more about Dr. Pugliese.

[ACT]IVATION TIP

“…ask your oncologist or your treating dermatologist whether your skin cancer, your non-melanoma skin cancer, if it is advanced or unable to be cut out completely, or whether there is any metastatic disease if you would be a candidate for immunotherapy.”

Download Guide  |  Download Guide en español

See More from [ACT]IVATED Non-Melanoma Skin Cancer

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An Oncodermatologist Shares Treatment Updates for Basal and Squamous Cell Skin Cancers

An Oncodermatologist Shares Treatment Updates for Basal and Squamous Cell Skin Cancers

How Do Non-Melanoma Skin Cancers Impact Non-White Populations?

How Do Non-Melanoma Skin Cancers Impact Non-White Populations?

Occupational Exposures and Non-Melanoma Skin Cancer | Understanding Risk Factors

Occupational Exposures and Non-Melanoma Skin Cancer | Understanding Risk Factors


Transcript:

Mary Leer:

Dr. Pugliese, what is the role of immunotherapy in patients with non-melanoma skin cancers, specifically those whose cancer is in an advanced stage or in their first line of treatment?

Dr. Silvina Pugliese:  

So one of the things that we learn about non-melanoma skin cancers is that the majority of those skin cancers are treated with easier and more localized treatments. So, for example, topical chemotherapy creams, a topical cream like imiquimod (Aldara, Zyclara) for some very early basal cell, or very, I should say superficial basal cell and also squamous cell cancer. And for patients that have more invasive disease, those are often treated surgically with surgical excision or most micrographic surgery for certain areas of the skin. That being said, we do have patients who go on to have more advanced skin cancer, and this is much more common in squamous cell cancer than it is in basal cell cancer.

And squamous cell cancer is the place where immunotherapy is being used the most currently. So currently immunotherapy is utilized in patients who have priMary Leer or recurrent locally advanced squamous cell cancer and are also non-surgical candidates or who have already had surgery but have high-risk disease or who have skin cancers that cannot be entirely resected or removed or cannot be operated on for a variety of different reasons or just cannot be removed completely.

We also utilize it in patients who have distant metastatic disease, meaning their skin cancer has moved beyond the area where it originated in and beyond local lymph nodes, for example. So it could be in another organ system entirely. And in those cases, we often can’t completely cut every area out. And so we use a systemic treatment such as immunotherapy.

In recent years, the medications called anti-PD-1 inhibitors have been shown to have some robust clinical data in terms of being a novel treatment option for patients with advanced squamous cell cancer that cannot be completely removed surgically or who have some of those other categorizations that we talked about. The two immunotherapies or immunotherapeutic agents that are most commonly used for squamous cell cancer currently are cemiplimab (Libtayo) and pembrolizumab (Keytruda). And those are systemic treatments that can be used alone without radiation.

And there are interestingly some ongoing trials looking at cemiplimab for treatment of basal cell cancer. So again, there are many less patients with advanced basal cell cancer. So the trials are not large. So it is mostly case reports, but there is some evidence that cemiplimab can be helpful for the treatment of basal cell carcinoma that is advanced or metastatic.

My activation tip for this question is to ask your oncologist or your treating dermatologist whether your skin cancer, your non-melanoma skin cancer, if it is advanced or unable to be cut out completely, or whether there is any metastatic disease if you would be a candidate for immunotherapy.


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An Oncodermatologist Shares Treatment Updates for Basal and Squamous Cell Skin Cancers

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An Oncodermatologist Shares Treatment Updates for Basal and Squamous Cell Skin Cancers from Patient Empowerment Network on Vimeo.

Which non-melanoma skin cancer treatments are showing promise? Expert Dr. Silvina Pugliese shares updates on treatments for basal cell carcinoma and squamous cell cancer.

Silvina Pugliese, M.D., is a Clinical Assistant Professor of Dermatology and Attending Physician at the Stanford Medicine Outpatient Center and Stanford Cancer Institute. Learn more about Dr. Pugliese.

[ACT]IVATION TIP

“…if you have a diagnosis, a new diagnosis of basal cell cancer and squamous cell cancer, to know that the treatment options that are available to you are often going to be things that are fairly minimally invasive. So you might be recommended to try a topical cream for the earlier variants of basal cell cancer and squamous cell cancer, or you will have an outpatient procedure to have the skin cancers cut out, either with a surgical excision or with the procedure called Mohs micrographic surgery.”

Download Guide  |  Download Guide en español

See More from [ACT]IVATED Non-Melanoma Skin Cancer

Related Resources:

How Do Non-Melanoma Skin Cancers Impact Non-White Populations?

How Do Non-Melanoma Skin Cancers Impact Non-White Populations?

Occupational Exposures and Non-Melanoma Skin Cancer | Understanding Risk Factors

Occupational Exposures and Non-Melanoma Skin Cancer | Understanding Risk Factors

Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers


Transcript:

Mary Leer:

Dr. Pugliese, what promising treatments are available for newly diagnosed patients with non-melanoma skin cancers?

Dr. Silvina Pugliese:

For the purposes of answering this question, I’m going to focus on the two most common types of non-melanoma skin cancer, which are basal cell cancer and squamous cell cancer. And one of the things I tell my patients who are newly diagnosed is letting them know that most basal cancer and most squamous cell cancer can be treated with fairly, and I’ll call them simple procedures or treatment in the sense that most of these skin cancers will not need any radiation or any type of chemotherapy or immunotherapy. So that’s the majority, it’s not all.

But, for example, for basal cell cancer, it’s really just a very low number of patients that have advanced basal cell cancer or metastatic basal cell cancer. For a very early stages of the disease or certain subtypes such as superficial basal cell cancer, which just lives on the top surface of the skin, we can even treat that with a topical medication, such as a topical chemotherapy medication called Fluorouracil or another topical cream called imiquimod (Aldara, Zyclara). For other subtypes of basal cell cancer, which invade a little deeper into the skin, surgical excision is preferred. If it’s in a functionally sensitive area such as the face, for example, this will generally be treated with the type of procedure called Mohs micrographic surgery. 

A very similar treatment algorithm exists for squamous cell cancer. Early squamous cell cancers that are insight to in the very top layer of the skin can also be treated, it’s off-label treatment, but can be treated with topical fluorouracil cream or topical imiquimod cream. And for squamous cell cancers that are more invasive or for squamous cell cancers that have some more aggressive features, those would be treated with surgical excision and in certain areas, Mohs micrographic surgery would be utilized. 

Activation tip for this question is that if you have a diagnosis, a new diagnosis of basal cell cancer and squamous cell cancer, to know that the treatment options that are available to you are often going to be things that are fairly minimally invasive. So you might be recommended to try a topical cream for the earlier variants of basal cell cancer and squamous cell cancer, or you will have an outpatient procedure to have the skin cancers cut out, either with a surgical excision or with the procedure called Mohs micrographic surgery.


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