Tag Archive for: non-melanoma skin cancer

Engaging in Advanced Non-Melanoma Skin Cancer Treatment Decisions

 

How can advanced non-melanoma skin cancer patients participate in their treatment and care decisions? This animated video provides an overview of the members of your healthcare team, tips for playing an active role in your care, and reviews factors that may impact skin cancer treatment options. 

 

Related Resources:

What Is Non-Melanoma Skin Cancer?

What Is Non-Melanoma Skin Cancer? 

What Do You Need to Know About Advanced Non-Melanoma Skin Cancer

What Do You Need to Know About Advanced Non-Melanoma Skin Cancer? 

An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research

An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research


Transcript:

Dr. Miller:

Hi, I’m Dr. Miller, and I am a dermatologic oncologist, which means I specialize in treating people with skin cancer. And this is my patient, Andrea, who has basal cell carcinoma, a type of non-melanoma skin cancer. 

Basal cell carcinoma is the most prevalent, but this group of cancers also includes.  

  • Squamous cell carcinoma 
  • And Merkel cell cancer, among other less common types 

Today, we’ll talk about who’s on your healthcare team, your role in care decisions, and the factors to consider when choosing a treatment. 

Andrea:

When I was diagnosed, it was a lot to take in. But through my conversations with Dr. Miller, I quickly learned that understanding my care and treatment options is essential. And, along with Dr. Miller, I had a whole team of providers that helped coordinate my care.  

Dr. Miller, can you share an overview of common members of a skin cancer care team? 

Dr. Miller:

Absolutely. Your healthcare team may include:  

  • A dermatologist, who focuses on skin health and manages your initial diagnosis. 
  • An oncologist, who specializes in cancer treatment, and may guide your overall treatment plan. 
  • There could also be a surgeon, who performs any necessary surgical procedures. 
  • And a radiation oncologist, who administers radiation therapy, if needed. 
  • And finally, there may be additional team members, such as a nurse navigator, to help coordinate your care or a social worker to aid with support and access to resources. 

I also want to add that YOU, the patient, are the central member of the healthcare team. So, let’s talk about YOUR role in your care. 

Andrea:  

Absolutely, as a patient, you should not be passive in your care. I always bring a list of questions to my appointments and make sure I understand the treatment options available to me.  Here’s advice for being engaged in your care: 

  • First, ask questions: Never hesitate to talk to your healthcare team about your diagnosis, treatment options, and what to expect at each stage of care. 
  • Next, be informed: Learn about your condition and the various therapies available. Advocacy groups, like the Patient Empowerment Network, can be very helpful. 
  • Always communicate openly: Share your symptoms, concerns, and preferences with your team. This helps tailor your treatment to your specific needs. 
  • And finally, advocate for yourself: If something doesn’t feel right, speak up. You can and should be involved in every decision about your care. 

Dr. Miller:

Those are great tips, Andrea. It’s also important to understand the factors that can impact treatment options. They include: 

  • The type and stage of skin cancer. 
  • Your overall health including other medical conditions that may affect therapy. 
  • The treatment goals that you determined with your care team. 
  • You should also consider a treatment’s potential side effects. Understanding the side effects can help you weigh the risks and benefits of each option. 
  • And, how treatment may impact your lifestyle, including your daily life, work, hobbies, and family time. 

Remember, you’re not alone in this journey. Your healthcare team is a support system that is here to guide and to assist you every step of the way.  

Andrea:

For more information and valuable resources, visit powerfulpatients.org. Thank you for joining us! 

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan from Patient Empowerment Network on Vimeo.

Are there key questions that advanced non-melanoma skin cancer patients should ask about their treatment plan? Dr. Anna Pavlick provides expert advice, emphasizing the importance of discussing treatment milestones and exploring alternative options if needed.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies


Transcript:

Katherine:

What questions should patients be asking about their proposed treatment plan? 

Dr. Pavlick:

I think it’s important to obviously know everything that you can about the medicine that you’re going to be given. What are the side effects? How does it work? Is it pills? Is it IV? Are you injecting something into me? In addition to that, I think patients also need to ask, “Well, how are you going to know that it’s working? When do we do scans? When do I get reevaluated?” Because again, not everybody is going to respond to every therapy. If we did, listen, I would retire and open up a dog reserve. But what is the milestone? 

How many cycles or how long before we determine this is working or this isn’t working? And many times, because patients have visible lesions on their skin, it’s not really hard to know whether something is working or not because you’re going to watch it get better or you’re going to see it get worse.

And many times, when patients ask me that, my answer is we have to see as we go along. But if we see it getting better, we keep going until it’s gone or it just stops shrinking. And then we talk about maybe removing it. On the contrary, if we give patients medicine and after let’s say two treatments, this spot on their skin has increased in size and looks like it’s growing, well, maybe we want to stop and reconsider what we’re doing and change to something different.  

What Are the Advantages of Seeing a Specialist for Skin Cancer?

What Are the Advantages of Seeing a Specialist for Skin Cancer? from Patient Empowerment Network on Vimeo.

What are the advantages of seeing a skin cancer specialist? Dr. Anna Pavlick highlights how specialists offer expertise in managing complex cases, like large lesions or tumors with associated lymph nodes, ensuring up-to-date treatment and collaborative care with local physicians.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies


Transcript:

Katherine:

What is the advantage of someone seeking care or to have an appointment with the skin cancer specialist?  

Dr. Pavlick:

Although for me, skin cancer is my life, skin cancers to the point where they require a medical oncologist are not all that common. Basal cell cancer and squamous cell cancer are very, very common in our population, but many times, they are managed by the dermatologist where you have an excision or you have a Mohs procedure. You don’t ever need to see an oncologist. However, if you have a very large lesion or you’ve got a lesion and you’ve got an associated lymph node or you’ve got a lesion that has what we call satellites or little tiny, I call them cousin tumors surrounding the primary lesion, you’re going to get referred to a medical oncologist.  

And many oncologists in the general community may or may not be very familiar with the up-to-date management because it’s not very common. The common cancers out there are breast cancer, lung cancer, colon cancer, prostate cancer. And general oncologists are very well-versed in how to manage those. I tell most patients you may not need to come to a big skin cancer referral center, but it may benefit you to come for an opinion and have a skin cancer oncologist work with your local doctor.  

And I do this all the time. Folks will come in and say, “You’re in New York City, but I live out in New Jersey. And coming into the city is just such a hardship. Is there any way I can do this outside?” And many times, my answer is if you’re not going to be participating in a clinical trial which is being run at my institution, I am more than happy to talk to your oncologist and work with them.

And it’s a collaboration. Many of us in academia are not looking to steal patients. We’re just looking to provide patients with the highest quality standard of care and are very, very happy to work with anybody that will provide that care to the patient to make sure that the patient can also get that care in a non-stressful setting.  

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment? from Patient Empowerment Network on Vimeo.

When should clinical trials be considered for advanced non-melanoma skin cancer treatment? Dr. Anna Pavlick explores the role of clinical trials, common patient concerns about participating in trials, and the phases of clinical trials in cancer research.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies


Transcript:

Katherine:

Where do clinical trials fit into a treatment plan for advanced non-melanoma skin cancer? 

Dr. Pavlick:

Again, my feeling is that clinical trials are opportunities for patients to be able to not only get the standard of care because many of our clinical trials offer patients the standard of care which is immunotherapy. 

But then we look to add something. And by adding something, can we make the responses faster, better, more durable? And that’s why asking your oncologist or your dermatologist about is there a clinical trial that I may be eligible for may make a huge impact on what happens.

We talked about immunotherapy. We talked about the targeted therapy. There are clinical trials that are now looking at injecting tumors with viral vectors. So, by injecting, we’re using the herpes virus which is the cold virus and injecting that directly into the lesion. Can that generate a better immune response to make things shrink up faster and provide more durable responses? 

And so, those are very exciting things. Most of these non-melanoma skin cancers have not metastasized. And even if they have, we’ve seen that if you inject the lesion that’s cutaneous, even if you have something that’s deeper, by really stimulating an immune response, you can not only contain the lesion that you’re injecting, but you will get a reciprocal response in the other lesions as well. So, it’s really a neat concept that’s really coming to fruition. 

Katherine:

What would you say to a patient who is hesitant in participating in a trial? 

Dr. Pavlick:

What do you got to lose? Patients are always very concerned that when they participate in a trial that they will get a placebo.  

Katherine:

Yeah. 

Dr. Pavlick:

And I think that’s the biggest hesitation and the biggest concern for many patients.  

And that has to be spelled out in the trial. The trial is going to say this is a trial where half of the patients are going to get a placebo or half of the patients are going to get X medicine. It is exceedingly rare in a treatment trial that there will be a placebo arm. Many times, if you’re talking about prevention, those are the studies that will want a control arm to get a placebo because the standard of care is you take this out, you do nothing and you watch.

Well, if you’re looking to see if doing something versus nothing is better, then they’re going to tell you. The standard is care is that we do nothing. However, in this trial, half the patients are going to get watched and get the standard of care. 

The other half of the patients are going to get either drug X or drug Y. And then at the end of the study, we’re going to see if those medicines actually benefited or didn’t benefit those patients compared to the patients who were just watched. Most patients who have active disease, whether it be locally advanced or metastatic are going to be offered trials that are either what we call a Phase I, a Phase II or a Phase III study.

So, a Phase I study is where we’re taking a brand new medicine that’s coming from the lab that looks to be very exciting. And we’re looking for what the side effects are and what is the right dose. So, it’s a very early trial where we’re not even sure what the toxicity is or what’s the right dose.  

Once we complete Phase I studies, we then get the information. So, we know the right dose. We know the side effects. We move onto a Phase II study. So, a Phase II study is where we’re going to look at a particular type of cancer and say everybody gets this drug at this dose and we know what the side effects are. We are looking to see if it truly is efficacious because from our very early research in the Phase I studies, we saw a group of patients with this particular type of cancer have a really nice response. And so, we’re looking for the efficacy of a drug in a Phase  II study. So, everybody gets treated. If we find something in the Phase II study that is a slam-dunk oh, my goodness, this looks terrific, we then go on to a Phase III study.

And so, a Phase III study is a randomized trial meaning half of the patients get one treatment. Half of the patients get the other treatment. Many times, I don’t get to pick what the patient gets. The patient doesn’t get to get what the patient picks. It’s randomized, but everybody gets a treatment. And Phase III studies take this new drug that we saw and got very excited about in the Phase II study, and we’ll compare it to the gold standard or the current standard of care for that particular disease. And then we compare the standard to the new treatment and see who wins. And that’s how we advance our learning. We advance what we do for people with this disease because if the new treatment does better than what we’re doing for everybody else, well now everybody else is going to get the new treatment.  

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick discusses targeted therapy, specifically hedgehog inhibitors for basal cell cancers, explaining how these therapies block cancer growth pathways, their rapid effectiveness, and potential side effects.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

What Are the Advantages of Seeing a Specialist for Skin Cancer?

What Are the Advantages of Seeing a Specialist for Skin Cancer?


Transcript:

Katherine:

How do targeted treatments to treat non-melanoma skin cancer?  

Dr. Pavlick:

Targeted therapies are approved for basal cell cancers in particular. They are certainly not for squamous cell or Merkel cell, but basal cell because basal cell cancers use a pathway called the patched and the smoothened pathway to multiply and metastasize or spread to other parts or just continue to grow.

And hedgehog inhibitors will inhibit that or block that particular pathway. These pathways are so highly overexpressed in basal cell cancers that we don’t even need to check when we do a biopsy. We don’t routinely check and send the biopsy to see if these tumors have those pathway alterations because 99.9 percent of them do. 

And so, we can easily give this targeted therapy to a patient with basal cell cancer. The nice thing about giving a targeted therapy is like shutting off a light switch. If the light is on and the cancer is using this pathway, if you shut the switch or block that pathway, things get better very, very quickly. Part of the downside to some of these hedgehog inhibitors are some of the side effects. Because basal cell cancers occur in older populations, these are patients that may in fact be sicker or more frail. And two of the side effects that can occur from hedgehog inhibitors is alteration in taste and the feeling that you’re just not hungry. 

So, anorexia and if you’ve got a thin frail patient and now you give them something that’s going to deter them from eating even more, they may be problematic. And not everybody gets those, but those are the most concerning. Patients do have a chance of having hair thinning or hair loss with hedgehog inhibitors. Another reason why many people just will say to me, “I don’t want them even though it will respond faster. I’d rather be treated with immunotherapy because then I’m not going to lose my hair.” And for a lot of women no matter what your age is, hair is an important part of who you are.  

Katherine:

Yeah.  

Dr. Pavlick:

And the last other significant side effect of hedgehog inhibitors is muscle cramps. And many times, this will happen in the middle of the night. People get really bad charley horses. 

I have patients who say they get cramps in their fingers or cramps in their hands. It’s not as easy to manage. We do know that sometimes by giving patients a medicine called amlodipine which is commonly used for blood pressure, this may help resolve or reduce the number of cramps they get, but it doesn’t work for everybody.

And so, you kind of have to balance out how quickly do you need this cancer to go away or respond? Because if you do use a hedgehog inhibitor, you’re going to get a very rapid response. If you use immunotherapy, just think about it. You’ve got to wake up your body’s immune system. You’ve got to get those T cells to get moving. And so, responses are not going to be in a matter of days. It’s going to more in a matter of weeks. With the hedgehogs, your responses are seen in a matter of days. 

Katherine:

Wow. So, sometimes, it could be a difficult decision to make?  

Dr. Pavlick:

Yeah, you have to weigh out pros and cons. Sometimes, you have patients who can’t swallow pills. Well, if you can’t swallow a pill, then a hedgehog inhibitor is not on your list of things that you can take. And to the contrary, some people are just really averse to having to come in and get an infusion because they may have needle phobia or they just don’t want an IV infusion. And then a hedgehog inhibitor is your first line of therapy.  

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer?

How Does Immunotherapy Treat Advanced Non-Melanoma Skin Cancer? from Patient Empowerment Network on Vimeo.

How does immunotherapy treat advanced non-melanoma skin cancer? Dr. Anna Pavlick delves into the mechanisms of immunotherapy and common side effects.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update

Treating Non-Melanoma Skin Cancer With Targeted Therapies

Treating Non-Melanoma Skin Cancer With Targeted Therapies


Transcript:

Katherine:

Dr. Pavlick, would you explain how immunotherapy uses a patient’s own immune system to treat cancer in the body? 

Dr. Pavlick:

Sure. Immunotherapy is very, very different than chemotherapy. As you know, with chemotherapy, chemotherapy is designed to attack rapidly dividing cells. And so, cells that are rapidly dividing are also some of your immune cells. 

And so, patients can get anemia. They can get problems where they’re at risk of infection because the bone marrow if moving very quickly. Immunotherapy on the other hand really doesn’t affect any cells that are rapidly dividing. I like to tell patients it wakes up their immune system. We all have what we call T cells that are living in our lymph nodes.

And immunotherapy really stimulates the body to produce more of those killer T cells and those memory cells and those cells that are out there to go and attack cancer and also creates memory. If, in fact, there is a cell that may be hiding or what we call dormant, if that cell were to decide it’s time to wake up and start growing, your immune system is going to remember the proteins that are on that particular cell and wake up your body’s immune system again to attack that cancer cell before it becomes a tumor. 

And so, that’s what we see with immunotherapy is when people have very dramatic responses and their immune system is able to eradicate their cancer, many times it’s a lifelong durable process. And so, because that immune system is constantly upregulated and on surveillance, we think that this translates into why people do so well for so long.  

Katherine:

So, which advanced non-melanoma patient type is immunotherapy right for? 

Dr. Pavlick:

Pretty much all of them.  

Anti-PD1 therapy, this is the most common type of immunotherapy that we use for non-melanoma skin cancers. And they’re approved for squamous cell cancer, basal cell cancer, Merkel cell, all very, very highly active and produce really impressively good results with long-term durable responses. So, sometimes when we talk about basal cell cancer, there are two types of therapies that we can talk about when it comes to basal cell.

We talk about immunotherapy, but we also talk about targeted therapies which are the hedgehog inhibitors. And there are pros and cons to both types of treatments, but when it comes to basal cell, we’ve got those two options. When it comes to Merkel cell and squamous cell, our first go-to option is really immunotherapy with anti-PD1 agent.  

Katherine:

But I wanted to know what the common side effects are for using immunotherapy to treat non-melanoma skin cancer. 

Dr. Pavlick:

Sure, when it comes to what we call adverse events or side effects from immunotherapy, when we give patients these single-agent anti-PD1 medicines, the chances of them having side effects are probably in about the 20 percent range. So, there’s a very large proportion of patients who are coming into the office getting these treatments and never have one side effect. But if you’re going to have any side effects, the most common side effects can be rash or itching.  

They don’t need to be together, so you can have a rash that doesn’t itch. You can itch and not have a rash. Those are really the skin toxicities. Sometimes with prolonged treatment, some patients may develop an underactive thyroid gland because the immune system will also attack some of the thyroid cells and slow down its function.

And so, those patients need to be given thyroid medicine. Fortunately or unfortunately, that’s one of the side effects that is a not-reversible side effect. And so, if we slow down your thyroid, you’re going to be committed to taking thyroid medicine for the rest of your life, which is essentially one tiny little pill every morning. But patients do need to know that. These drugs get metabolized by the liver and the kidneys. 

And so, before we give patients their infusion, we always check their liver and their kidneys to make sure that the immunotherapy hasn’t caused an inflammation of the liver or an inflammation of the kidneys making it not safe to give immunotherapy at that point in time. It doesn’t mean that we can’t go back and give it again. We just need to let those organs recover. Give them medicines to calm down the inflammation and then we can resume treatment.

Any time you give patients an immunotherapy, the side effects can be very vast because they cause inflammatory side effects. So, anything that you can put an -itis on the back of it, so dermatitis meaning inflammation of the skin, colitis meaning inflammation of the colon which can lead to diarrhea or bloating or a feeling of some baseline nausea if it affects the small bowel instead of the large bowel. 

Pneumonitis is an inflammation of the lungs. Any kind of -it is, one of the more rare things is what we call uveitis and it’s an inflammation of the back of the eye where it makes it difficult for patients to see, very easily diagnosed by an ophthalmologist and treated with either steroid eye drops or a short course of oral steroids that will get everything calmed down. And even if that happens, it doesn’t mean that you can’t go back and retreat those patients. So, any type of inflammatory symptom is a potential side effect.  

Advanced Non-Melanoma Skin Cancer Research Update

Advanced Non-Melanoma Skin Cancer Research Update from Patient Empowerment Network on Vimeo.

Dr. Anna Pavlick highlights ongoing research into preoperative immunotherapy in non-melanoma skin cancer. Dr. Pavlick emphasizes the importance of clinical trials and provides guidance on how to inquire about participating in these studies.

Dr. Anna Pavlick is a medical oncologist and the founding Director of the Cutaneous Oncology Program at Weill Cornell Medicine and NewYork-Presbyterian. Learn more about Dr. Pavlick.

See More from Evolve Non-Melanoma Skin Cancer

Related Resources

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

When Should Clinical Trials Be Considered for Advanced Non-Melanoma Skin Cancer Treatment?

Questions to Ask About Your Advanced Non-Melanoma Skin Cancer Treatment Plan

What Are the Advantages of Seeing a Specialist for Skin Cancer?

What Are the Advantages of Seeing a Specialist for Skin Cancer?


Transcript:

 Katherine:

What research is showing promise? What are you excited about? 

Dr. Pavlick:

Oh, my goodness. Skin cancer research is really skyrocketing. 

We have been able to use immunotherapy. Again, we developed this in metastatic melanoma but have really looked at the large-tumor mutational burden that squamous cell and basal cell cancers have as well as Merkel cell and have been able to take immunotherapy from one setting and apply it to the next setting.

And we’ve seen some really spectacular results. Many times, we were just using immunotherapy to treat these malignancies, but the thought process has been well, what happens if we move it sooner and we give it to patients before we take them to the operating room?  

So, I think the thing that’s really been exciting has been looking at giving immunotherapy prior to surgery rather than giving it as prevention after surgery. 

And the reason we found that very meaningful is that we did a clinical trial giving patients somewhere between two and four cycles of preoperative treatment. And then we took them to the operating room which gave us the opportunity to look at that tumor and see what the immunotherapy did to the cancer. And a very high percentage, more than 50 percent of those patients were found to have no cancer whatsoever left in the specimen that was removed from their body.

And so, now we’ve got studies going on saying since patients have the potential to do so well with immunotherapy before surgery, A, do we even need to do surgery? B, if we do take them to the operating room, do we need to give them more preventive immunotherapy or can we just say you had such a great response, you’re done with treatment? 

 

And so, there is lots of exciting things that we’ll be identifying within the next few years that really, I think, is going to make a huge impact on patient’s lives. If we find out that immunotherapy can eradicate cancers, we may prevent people from having to go to the OR for resection. So, stay tuned for that, very exciting.   

Katherine:

How can patients learn more about research? What sorts of questions should they be asking their healthcare team?  

Dr. Pavlick:

I think research to me is always an opportunity because this is how we move science forward. 

So, I think whenever a patient is given a diagnosis of a cancer, whether it be an early-stage cancer or a later stage cancer, I think their physicians are obligated to really talk to them about clinical trial options for them.  

And sometimes, in early-stage cancers, there aren’t any. But sometimes there are prevention studies that may be taking place that once they get the diagnosis, they get treated for their cancer. They may be eligible to participate in prevention studies. So, I think that should always be a question that patients ask is, “Okay, other than the standard of care, are there any research studies that I may want to consider or need to know about?”  

Advice for Accessing Advanced Non-Melanoma Skin Cancer Clinical Trials

Advice for Accessing Advanced Non-Melanoma Skin Cancer Clinical Trials from Patient Empowerment Network on Vimeo.

Participating in advanced non-melanoma skin cancer clinical trials may feel overwhelming for some patients. Dr. Soo Park discusses how clinical trials fit into patient care and shares advice for overcoming obstacles to accessing cutting edge therapies.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

 

Related Resources:

Non-Melanoma Skin Cancer Staging | What Patients Should Know

Non-Melanoma Skin Cancer Staging | What Patients Should Know

Advanced Non-Melanoma Skin Cancer | Establishing a Treatment Plan

Advanced Non-Melanoma Skin Cancer | Establishing a Treatment Plan

An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research

An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research


Transcript:

Katherine:

Beyond what has been approved to treat advanced non-melanoma skin cancer, where do clinical trials fit in?  

Dr. Park:

Clinical trials are great, because they’re the reason why we have the drugs that we have today that are working so effectively. And so, I’m really fortunate to be at a center where we offer clinical trials for patients.  

Clinical trials always fit in at any point in the journey, as long as they fit your disease. So, most of the clinical trials we have are for patients that have advanced disease, not for early stage, because the early stage patients don’t really need it; because with just simple surgery, they tend to do really well, and their cancer doesn’t really ever come back and cause issues.  

But clinical trials are really important, because they’re the only way we can study a promising treatment option; see how well it works, and if it works really well, then move it further on to hopefully help a lot of other people. And that’s why we have immunotherapy today – is through clinical trials; and immunotherapy is used for lots of cancers.  

Katherine:

Are there barriers to accessing trials? And if so, do you have any recommendations on how to tackle them?  

Dr. Park:

Yeah, there are barriers to trials, and I think the thing that the cancer community is really trying to work on is barriers to accessing trials if you’re from an underrepresented population in medicine. So, based on your socioeconomic status, meaning how much money do you make or what your education level is, what race are you, what ethnicity, what is your background; because we know that there’s a disparity for those individuals. And so, I think really asking your doctor, staying curious; asking them, “Could a clinical trial help me?” 

Even if you have no idea of really what trials there are, or what they really mean, you can just throw that word out; and that then, the doctor knows that you’re potentially interested, and they can actually give you the information and help you learn more about it, even if you don’t know much about it; because I think it’s still quite a black box, and we’re trying to overcome this barrier, but it’s difficult.  

Katherine:

And what about researching clinical trials online? What sites would you recommend?  

Dr. Park:

So, I have to admit that there are multiple sites, but sometimes they are not very patient-friendly. Even whenever I look at them, they are not very friendly. I think the largest repository of clinical trials is the NCI database. It’s just where every clinical trial that’s open has to be registered, and it’s run by the federal government, I believe. And because it’s not super regulated, it’s just the person working on the trial entering information, and they’re typically of a medical background, sometimes the information is not very easy to digest or understand.  

So, I think really just letting your medical team know that you might be interested in a trial, then they can help you find the right trial for you. And if they don’t have one, they can tell you other areas or other centers that might have one. You are more than welcome to go search in Google and all that, but it can be really hard, and then I don’t want that to make the patient feel that this is not for them.  

Advances in Non-Melanoma Skin Cancer Treatment and Monitoring

Advances in Non-Melanoma Skin Cancer Treatment and Monitoring from Patient Empowerment Network on Vimeo.

How have advances in non-melanoma skin cancer treatment and testing changed patent care? Dr. Soo Park discusses the impact of innovations in research and disease monitoring.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

 

Related Resources:

Non-Melanoma Skin Cancer Staging | What Patients Should Know

Non-Melanoma Skin Cancer Staging | What Patients Should Know

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease

What Patients Should Know About Non-Melanoma Skin Cancer Progression?

What Patients Should Know About Non-Melanoma Skin Cancer Progression


Transcript:

Katherine:

Dr. Park, we’ve been hearing a lot about innovations in technology. How are these advances improving skin cancer care?  

Dr. Park:

They’re improving care, because we can offer patients more minimal procedures. We can tell them you don’t need this type of other treatment, and you can have the same outcome. So, we can tell you need less treatment, and the outcomes are just as good, because sometimes more treatment is not always better. More treatment sometimes means more toxicity, more time away from family, more time away from home. Advances mean that we can keep you cancer-free for longer.  

Or even if I can’t ever get rid of the cancer, we have drugs that can keep it under control for a long time, and it stays under control, even if I stop the medicine. So, all those are really remarkable things for our patients, that we have options that can help them live healthy, full lives.  

Katherine:

How do you know if a treatment is working? How is a patient’s response monitored?  

Dr. Park:

For skin cancer, that’s pretty easy, and I think that’s one of the most satisfying things, because I can often see the cancer visibly. I don’t always have to rely on a scan, as for some patients for the cancers in their stomach or something like that. So, patients will often see a dramatic reduction in the size of their tumor, sometimes even after the first treatment I give them. And not only can we tell by looking at them; eventually, I will get a scan to compare it to the scan they had it in the first place, and we see that the tumor has gotten a lot smaller. 

Advanced Non-Melanoma Skin Cancer | Establishing a Treatment Plan

Advanced Non-Melanoma Skin Cancer | Establishing a Treatment Plan from Patient Empowerment Network on Vimeo.

What advanced non-melanoma skin cancer therapies might comprise a treatment plan? Dr. Soo Park discusses therapy types, the impact of molecular testing, and shares key questions to ask about your treatment plan.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

 

Related Resources:

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease

 Advances in Non-Melanoma Skin Cancer Treatment and Monitoring

Advances in Non-Melanoma Skin Cancer Treatment and Monitoring

Advice for Accessing Advanced Non-Melanoma Skin Cancer Clinical Trials

Advice for Accessing Advanced Non-Melanoma Skin Cancer Clinical Trials


Transcript:

Katherine:

So, what is the typical treatment path for someone who’s been diagnosed at this stage of disease, at the advanced stage?  

Dr. Park:

Yeah, so, before – and I really love this question, because in the past, we did not have that much to offer patients except surgery, and then they would get a very extensive surgery. They would get reconstruction. But sometimes it’s hard to get reconstruction after a really major surgery, because you have to heal, and you have to get better. And then, after the surgery, you would typically get radiation to try to prevent the cancer from coming back. But nowadays, we have immune therapy.  

So, immune therapy is a certain type of IV medicine that’s not chemotherapy that works really well for squamous cell skin cancer. And so, nowadays, we can actually give this to you before surgery. So, we can give you a couple of doses of this IV immune therapy medicine before surgery, and really shrink your tumor quite dramatically.  

And then, that makes the surgery a lot easier, smaller. And then, sometimes after we do the surgery, and then we look at what the surgeon has taken out under the microscope, we can’t see any tumor left. And that’s really amazing, because then sometimes we don’t even need to do radiation. So, not only did we make your tumor a lot smaller, sometimes we completely made it go away.   

And then, if that happens, sometimes we don’t even need to do radiation. So, it really helps the patient. And I think this is really important, because this is somewhat newer data, and I still see patients that get referred to me for just surgery. 

But I think a lot of head and neck surgeons are now aware of this data. And so, this is something that’s, I think, becoming more common.  

Katherine:

What about targeted therapies?  

Dr. Park:

So, targeted therapies are, I think, mainly used in basal cell skin cancer. So, targeted therapies are typically oral medications or pills. They’re called targeted, because they’re used in cancers that have a specific target. So, for example, the basal cell skin cancer, the target is the hedgehog pathway, because the hedgehog pathway is abnormal. And so, these pills, they specifically target the hedgehog pathway. But for squamous cell skin cancer, we don’t have any true targeted therapies.  

Katherine:

As patients are reviewing their options with their doctor, what questions should they be asking about their care plan? 

Dr. Park:

I think all patients should be asking, what the goal of the treatment is. They should be asking, especially if they’re being offered any type of treatment, what are the side effects? What can I expect from this, in terms of how much better will it make me? They should really ask about how often the treatments are given, because some patients have transportation issues or financial barriers, and we want to know about that, so we can help them.   

Patients should also ask about any necessary blood work that is needed. They should ask what can they do in the future to prevent a similar type of cancer happening, and just make sure that they’re talking to their families, because I think social support is really important.  

Katherine:

Yeah. I think it’s important for patients to ask how the cancer is going to impact their lives overall, really.  

Dr. Park:

Yeah, exactly, because it will affect every single aspect of your life: your social life, your family life, your mental health, your physical well-being. And so, it’s really important to know and work with your doctor on what you think you can expect now, and also in the future.  

Katherine:

Yeah. Well, how do test results impact treatment options, then? 

Dr. Park:

So, there are sometimes when we have a skin cancer that actually happens inside a gland in your face. It’s one of the salivary glands in your face. And we sometimes don’t know if it’s a skin cancer that happened on the outside and that spread to the gland inside your face, or did it actually first just start inside the gland? Because a cancer that just starts inside the gland is not technically a skin cancer. It’s a different type of head-and-neck cancer, and it’s very, very rare, and it’s treated very differently.  

So, nowadays, because we have that molecular testing, like I talked about, I see lots of patients where they have a cancer in their salivary or parotid gland. We don’t know where it came from. And so, we send it for molecular sequencing or molecular testing, and there are certain clues in the molecular testing that can tell us, oh, it probably actually came from a skin cancer.  

You just didn’t know it; or maybe it’s the skin cancer that kind of was there and went away; or maybe it was a skin cancer you had like five years ago, that you didn’t think caused any problems, but it did spread, because knowing where it came from through molecular sequencing, if it’s really hard to find out where, really impacts the treatment I may give you. 

Katherine:

What about side effects of these therapies? How are they managed?  

Dr. Park:

Yeah, so, for immunotherapy, there’s one specific side effect that we don’t find with chemotherapy, and that’s really when your body’s own immune system kind of ends up attacking the other parts of your body. And so, it can cause inflammation of other organs. And so, for patients that experience that, it can be very mild, and it can be all the way to very severe, requiring a patient to go to the hospital.  

But in all cases, we just have to tell the immune system to quiet down a bit, because it’s attacking your body. And so, the way we do that is we give the patient steroids. And so, if it’s really mild, maybe you have like a small rash; maybe we can just give you a steroid cream, or maybe we have to give you a steroid pill. But sometimes, if it’s really severe, we have to tell you to go to the hospital so you can get steroids through your IV. 

What Patients Should Know About Non-Melanoma Skin Cancer Progression?

What Patients Should Know About Non-Melanoma Skin Cancer Progression from Patient Empowerment Network on Vimeo.

What’s vital for non-melanoma skin cancer patients to know about disease progression? Dr. Soo Park explains the stages of non-melanoma skin cancer and what it means to have advanced skin cancer. 

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

Katherine:

How do these cancers typically progress? What are the stages?  

Dr. Park:

Yeah, so, if it’s just a really small cancer like that’s on your face, it’s typically an early stage or a stage I. And I’m specifically talking about squamous cell skin cancer, because actually for basal cell, we don’t have any formal staging for basal cell.  

Katherine:

Why is that? 

Dr. Park:

It just wasn’t included in the staging systems. So, for basal cell, there’s no formal staging criteria, but we’ll stage it as early stage based on what we think, as a clinician, when we see you; or if we get imaging and we see that it’s spread to other areas, it may be later stage. But for squamous cell skin cancer, it’s earlier stage depending on the size. Sometimes when we get a biopsy, and in the biopsy, if we find high risk things in the biopsy, that may actually put you at a higher stage, even if the cancer is somewhat small.  

So, that could be like a stage III. But if at any point we find on imaging that the cancer has spread elsewhere – so, like you have a cancer that has spread to your liver, or to your lungs, or to the bones in your body, that’s a stage IV. 

Katherine:

Okay. And when is the cancer considered advanced? 

Dr. Park:

I think the cancer would be considered advanced if it’s not something that a surgeon can simply just remove. So, the dermatologist cannot just do a standard Mohs surgery, or the head-and-neck surgeon cannot just do a standard surgery, because advanced means that the cancer is either pretty deep, pretty large; or the surgeon can do surgery, but that means that the surgery would be very disfiguring. Sometimes these lesions can be really big on the face. 

And sure, the surgeon could do the surgery, but if we have to take part of your eye, or part of your nose or your ear, and you have to have major reconstruction, that’s considered probably more of an advanced tumor. 

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease

Advanced Non-Melanoma Skin Cancer Test Results | Understanding YOUR Disease from Patient Empowerment Network on Vimeo.

What should advanced non-melanoma skin cancer patients know about test results? Dr. Soo Park explains the types of skin cancer tests and reviews questions you can ask your healthcare team to help better understand test results. 

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

Katherine:

So, once a patient has been diagnosed, what are the tests that help understand more about the patient’s individual disease?  

Dr. Park:

So, it’s always important to get a biopsy, so then we can tell which type of non-melanoma skin cancer it is. 

And that’s when we look at your cancer under the microscope, and a special doctor called a pathologist. And actually, they’re also really important as part of our multidisciplinary team. They look at the tumor under the microscope, and they help us decide and tell us which type of non-melanoma skin cancer it is. 

But aside from that, I think imaging is really important. So, that are things like CT scans, MRI scans. Sometimes we have to also recommend a PET scan, which is another type of special scan. And these images are really to help us look deeper into the structure of your body, because I can only see so much from the outside.  

And they can really help us tell how deep is the cancer; is the cancer around any critical structures? Is it anywhere else in the body? Because if we find cancer far away from where it originally occurred, that may tell us that the cancer is a later stage.  

Katherine:

So, let’s just go with a scenario. Somebody comes in to you, and they have a lesion on their cheek, for instance.   

Would you do a whole body MRI or a CT scan to see if that…once you’ve done a biopsy, you find that it’s cancerous. Would you do a whole body MRI, or a scan of some sort, to see if the cancer was anywhere else?  

Dr. Park:

So, we typically don’t, because we know the patterns that – for instance, like you mentioned, like a skin cancer in your cheek can go to. And so, non-melanoma skin cancers on the face or anywhere in the body, they typically like to go to the lymph nodes that drain that area. And so, if you have a lesion on your face, that’s typically your neck.   

And so, we’ll do a good exam of your face, your neck, but we will also get imaging of those areas. So, we typically get an imaging focused on the head and neck. If we find something abnormal there, then that may tell us we need additional imaging in the other parts of the body. But more often than not, we don’t start with a whole body scan.  

Katherine:

Okay. What questions should patients ask about their test results?  

Dr. Park:

So, I think patients should definitely ask, “What type of skin cancer do I have? How did it arise? Where all in my body is the skin cancer? What does my blood work look like?” And I think patients should also be aware that for many years now, we send tumor samples for something called molecular sequencing, and that just tells us different types of mutations that may be in your tumor. And that’s really important, because there are some drugs we have now that are only for patients that have specific mutations in their tumor.  

And so, if you are one of those patients that has a specific mutation, that opens the door to another type of therapy for you. And, you know, that’s something that’s now recommended, actually, by a lot of cancer societies, to really send your tumor for some type of molecular sequencing, so we can level the playing field for all patients, and offer them the full range of treatments that we have.  

Katherine:

Yeah. What are the common mutations?  

Dr. Park:

So, for basal cell skin cancer, almost all basal cell skin cancers are driven by abnormality in a certain pathway called the hedgehog pathway. Yeah, I’m – 

Katherine:

Interesting. Why? 

Dr. Park:

It was named, I think, by someone. All these names are people by someone that discovered it, and they get the rights to name the pathway. But for a basal cell, it’s the hedgehog pathway. And so, in the hedgehog pathway, there are certain types of mutations specifically associated with that pathway. And one of them, among these mutations, we look for drugs that can inhibit this pathway. So, there are drugs that specifically target the hedgehog pathway.  

They’re called hedgehog inhibitors, and they’re oral medications or pills that you can take every day. And those are for patients with basal cell skin cancer, because the basal cell skin cancer came about because the hedgehog pathway is not normal. But for squamous cell skin cancer, squamous cell skin cancer often has a lot of mutations. And unfortunately, they’re the type of mutations that we actually don’t have a drug for at this moment. But one unique thing about squamous cell skin cancer is that it has so many mutations.  

And so, that means that it has a better chance of responding to a different type of treatment. It’s an IV treatment known as immunotherapy. And so, that’s something that’s relatively recent, I think, in the past five years now. We’ve started using immunotherapy for patients that have squamous cells skin cancer, and it’s worked remarkably well. 

Non-Melanoma Skin Cancer Staging | What Patients Should Know

Non-Melanoma Skin Cancer Staging | What Patients Should Know from Patient Empowerment Network on Vimeo.

How is non-melanoma skin cancer staged? Dr. Soo Park explains the process of determining the cancer’s stage and reviews factors that impact staging.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

Katherine:

So, who typically diagnoses this stage of skin cancer? Is it a dermatologist, or somebody else?  

Dr. Park:

So, that really depends on the stage of the skin cancer. So, when I say stage, I mean how advanced is it. For an early stage skin cancer, those are typically really small. And oftentimes, patients will have a few of these; and some patients have a lot of these, maybe on their face, their neck, their scalp, across their hands and arms. And typically, they notice a small lesion that won’t go away or is getting a little bit irritated. 

And so, they see the dermatologist first. So, the dermatologist is often the first person that sees patients whenever the patient has noticed like a small skin abnormality that’s not getting better. But sometimes, they also see patients that do not see the dermatologist first.  

They actually either see a medical oncologist like myself, or a head and neck surgeon who I work closely with, because some patients have a tumor or a cancer that’s really large, and it’s too large to the point where a dermatologist is not able to offer them anything. And so, if the tumor is really large, that’s a later stage cancer. So, it’s not as early stage. 

What Are Non-Melanoma Skin Cancers and Where Do They Develop?

What Are Non-Melanoma Skin Cancers and Where Do They Develop? from Patient Empowerment Network on Vimeo.

What is non-melanoma skin cancer, and what are the different types? Dr. Soo Park defines this group of skin cancers and explains where they are typically found on the body.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about Dr. Park.

Download Resource Guide

Katherine:

So, Dr. Park, non-melanoma skin cancer is a group of cancers. Would you define it for us?  

Dr. Park:

Yeah, so, non-melanoma skin cancers is just basically a broad blanket term for any skin cancer that is not a melanoma. And so, that’s things like basal cell skin cancer, squamous cell skin cancer, Merkel cell skin cancer. So, anything that’s not considered a melanoma. A melanoma is another type of skin cancer, but it develops from a different type of skin cell.  

Katherine:

Okay, that’s good to know. So, what are the most common types of non-melanoma skin cancer? I think you’ve just mentioned that, but maybe you could mention them again, and maybe define each one.  

Dr. Park:

Yeah, so, there are lots of different types of non-melanoma skin cancers, but the two most prevalent ones are basal cell skin cancer and squamous cell skin cancer, and they actually both come from the same cell of origin in the skin. but there are actually two different types of skin cancers because ultimately that one cell, develops into another cell.  

And so, for basal cell skin cancer, the cell that it comes from is a basal cell, and that’s why it’s called basal cell skin cancer. And that is very different than squamous cell skin cancer. So, as the name says, squamous cell skin cancer actually comes from a squamous cell, and these are both cells that are in your skin, and both of these cancers are mainly driven by the sun exposure.  

But even though they’re both non-melanoma skin cancers and they’re the most common, with basal cell being the number one most common skin cancer actually in the world, I think a lot of people don’t recognize that, because we don’t capture the occurrences of basal cell skin cancer very well, because it’s so common. But those are the two main types of skin cancers that I think a lot of treatments are focused on right now.   

Katherine:

And are these cells – can they develop into cancer anywhere on the body, on the skin of the body?  

Dr. Park:

Yeah, so, anywhere that you have any type of cutaneous skin, these cells reside, and typically they happen in areas where the skin is exposed to the sun. So, for example, they often happen on the head and neck, because we just get lots of sun exposure there.  

Advanced Non-Melanoma Skin Cancer Treatment | Partnering With Your Team on Care Decisions

Advanced Non-Melanoma Skin Cancer Treatment | Partnering With Your Team on Care Decisions from Patient Empowerment Network on Vimeo.

 When making advanced non-melanoma skin cancer care and treatment decisions, what factors help determine the best approach for YOUR disease? Dr. Soo Park reviews current treatment options, emerging research, and shares advice for partnering with your healthcare team.

Dr. Soo Park is a Medical Oncologist at Moores Cancer Center at UC San Diego Health. Learn more about this expert.

 

Related Resources:

An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer ResearchAn Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research What Do You Need to Know About Advanced Non-Melanoma Skin CancerWhat Do You Need to Know About Advanced Non-Melanoma Skin Cancer? What Is Non-Melanoma Skin Cancer?


Transcript:

Katherine:

Hello and welcome. I’m your host, Katherine Banwell. In today’s program, we’ll be discussing advanced non-melanoma skin cancer, what it is, how it’s treated, and you’ll learn tools for advocating for yourself.   

This program is part of the Patient Empowerment Network toolkit series, which was created with the goal of helping patients learn more about their cancer and empower them to play a proactive role in their care. Before we meet our guest, let’s review a few important details. The reminder email you received about this program contains a link to program materials. If you haven’t already, click that link to access a guide to help you follow along during the webinar.  

At the end of this program, you’ll receive a link to a program survey. Please take a moment to provide feedback about your experience today, in order to help us plan future webinars. And finally, before we get into the discussion, please remember that this program is not a substitute for seeking medical advice. Please refer to your healthcare team about what might be best for you.  

Well, let’s meet our guest. Joining us is Dr. Park. Welcome. Would you please introduce yourself?  

Dr. Park:

Great, thanks. So, my name is Sue Park, and I’m an associate professor of medicine at the University of California here in San Diego, and I focus on cutaneous oncology. So, I see patients with all types of skin cancers. And in particular, I focus on non-melanoma, because I think most patients realize that the other skin cancer that is widely known is melanoma.   

Katherine:

Okay, that’s great. Thank you so much for dividing that up, and thanks for taking the time to join us today.  

Dr. Park:

Yeah, of course.  

Katherine:

So, Dr. Park, non-melanoma skin cancer is a group of cancers. Would you define it for us?  

Dr. Park:

Yeah, so, non-melanoma skin cancers is just basically a broad blanket term for any skin cancer that is not a melanoma. And so, that’s things like basal cell skin cancer, squamous cell skin cancer, Merkel cell skin cancer. So, anything that’s not considered a melanoma. A melanoma is another type of skin cancer, but it develops from a different type of skin cell.  

Katherine:

Okay, that’s good to know. So, what are the most common types of non-melanoma skin cancer? I think you’ve just mentioned that, but maybe you could mention them again, and maybe define each one.  

Dr. Park:

Yeah, so, there are lots of different types of non-melanoma skin cancers, but the two most prevalent ones are basal cell skin cancer and squamous cell skin cancer, and they actually both come from the same cell of origin in the skin. but there are actually two different types of skin cancers because ultimately that one cell, develops into another cell.  

And so, for basal cell skin cancer, the cell that it comes from is a basal cell, and that’s why it’s called basal cell skin cancer. And that is very different than squamous cell skin cancer. So, as the name says, squamous cell skin cancer actually comes from a squamous cell, and these are both cells that are in your skin, and both of these cancers are mainly driven by the sun exposure.  

But even though they’re both non-melanoma skin cancers and they’re the most common, with basal cell being the number one most common skin cancer actually in the world, I think a lot of people don’t recognize that, because we don’t capture the occurrences of basal cell skin cancer very well, because it’s so common. But those are the two main types of skin cancers that I think a lot of treatments are focused on right now.   

Katherine:

And are these cells – can they develop into cancer anywhere on the body, on the skin of the body?  

Dr. Park:

Yeah, so, anywhere that you have any type of cutaneous skin, these cells reside, and typically they happen in areas where the skin is exposed to the sun. So, for example, they often happen on the head and neck, because we just get lots of sun exposure there.  

Katherine:

Yeah, yeah, okay. So, who typically diagnoses this stage of skin cancer? Is it a dermatologist, or somebody else?  

Dr. Park:

So, that really depends on the stage of the skin cancer. So, when I say stage, I mean how advanced is it. For an early stage skin cancer, those are typically really small. And oftentimes, patients will have a few of these; and some patients have a lot of these, maybe on their face, their neck, their scalp, across their hands and arms. And typically, they notice a small lesion that won’t go away or is getting a little bit irritated.  

And so, they see the dermatologist first. So, the dermatologist is often the first person that sees patients whenever the patient has noticed like a small skin abnormality that’s not getting better. But sometimes, they also see patients that do not see the dermatologist first.  

They actually either see a medical oncologist like myself, or a head and neck surgeon who I work closely with, because some patients have a tumor or a cancer that’s really large, and it’s too large to the point where a dermatologist is not able to offer them anything. And so, if the tumor is really large, that’s a later stage cancer. So, it’s not as stage.  

Katherine:

Yeah. Now, this may seem like a silly question, but don’t the cells sometimes show up at like a mole, so you wouldn’t even know you had it?  

Dr. Park:

Yeah. So, that’s more common for melanoma. It can show up as a mole, but you’re exactly right. For both non-melanoma skin cancers like basal cell and squamous cell skin cancer, it can look just like a little lesion that you might have thought you hit yourself on like the door handle, and it’s not getting better.  

Some of these cancers actually appear, and then they go away on their own, and then they come back. And so, sometimes it’s really hard to see that it is a skin cancer, it was a skin cancer. But I think what’s really important is that it’s a lesion that’s either getting worse, or it’s not going away, so you should really tell your doctor about.  

Katherine:

Yeah. We know that there’s a multidisciplinary team involved with advanced non-melanoma skin cancer care. Who are the members on the team?  

Dr. Park:

So, I think now, because we have so many more treatments to offer patients, if I’m specifically talking about a non-melanoma skin cancer on the head and neck, which is where it most commonly occurs, because of sun exposure, I think the multidisciplinary team is really important. That typically consists of a medical oncologist like myself, typically a head-and-neck surgeon, and sometimes a plastic surgeon, as well, depending on what we come up with as a treatment plan.  

It also often involves a radiation oncologist. So, that’s a special type of doctor that gives radiation treatment. We always want to keep the dermatologist involved, as well, because most of these patients do have a primary dermatologist that’s been really involved in their care.  

Katherine:

What about other people on the healthcare team, like that are in a supportive form on the team? 

Dr. Park:

Yeah, that’s just as important, because a lot of these patients may have barriers to care, or they may have social factors that affect their ability to get the care that they deserve, and that they need. 

So, we work really closely with social workers, with nurse navigators, even speech therapists. Sometimes if the cancer is involving some really close to your lip or mouth, sometimes that can be really difficult. We work a lot with audiologists, as well. So, we have a really great multidisciplinary team.  

Katherine:

So, once a patient has been diagnosed, what are the tests that help understand more about the patient’s individual disease?  

Dr. Park:

So, it’s always important to get a biopsy, so then we can tell which type of non-melanoma skin cancer it is. 

And that’s when we look at your cancer under the microscope, and a special doctor called a pathologist. And actually, they’re also really important as part of our multidisciplinary team. They look at the tumor under the microscope, and they help us decide and tell us which type of non-melanoma skin cancer it is. 

But aside from that, I think imaging is really important. So, that are things like CT scans, MRI scans. Sometimes we have to also recommend a PET scan, which is another type of special scan. And these images are really to help us look deeper into the structure of your body, because I can only see so much from the outside.  

And they can really help us tell how deep is the cancer; is the cancer around any critical structures? Is it anywhere else in the body? Because if we find cancer far away from where it originally occurred, that may tell us that the cancer is a later stage.  

Katherine:

So, let’s just go with a scenario. Somebody comes in to you, and they have a lesion on their cheek, for instance.   

Would you do a whole body MRI or a CT scan to see if that…once you’ve done a biopsy, you find that it’s cancerous. Would you do a whole body MRI, or a scan of some sort, to see if the cancer was anywhere else?  

Dr. Park:

So, we typically don’t, because we know the patterns that – for instance, like you mentioned, like a skin cancer in your cheek can go to. And so, non-melanoma skin cancers on the face or anywhere in the body, they typically like to go to the lymph nodes that drain that area. And so, if you have a lesion on your face, that’s typically your neck.   

And so, we’ll do a good exam of your face, your neck, but we will also get imaging of those areas. So, we typically get an imaging focused on the head and neck. If we find something abnormal there, then that may tell us we need additional imaging in the other parts of the body. But more often than not, we don’t start with a whole body scan.  

Katherine:

Okay. What questions should patients ask about their test results?  

Dr. Park:

So, I think patients should definitely ask, “What type of skin cancer do I have? How did it arise? Where all in my body is the skin cancer? What does my blood work look like?” And I think patients should also be aware that for many years now, we send tumor samples for something called molecular sequencing, and that just tells us different types of mutations that may be in your tumor. And that’s really important, because there are some drugs we have now that are only for patients that have specific mutations in their tumor.  

And so, if you are one of those patients that has a specific mutation, that opens the door to another type of therapy for you. And, you know, that’s something that’s now recommended, actually, by a lot of cancer societies, to really send your tumor for some type of molecular sequencing, so we can level the playing field for all patients, and offer them the full range of treatments that we have.  

Katherine:

Yeah. What are the common mutations?  

Dr. Park:

So, for basal cell skin cancer, almost all basal cell skin cancers are driven by abnormality in a certain pathway called the hedgehog pathway. Yeah, I’m – 

Katherine:

Interesting. Why? 

Dr. Park:

It was named, I think, by someone. All these names are people by someone that discovered it, and they get the rights to name the pathway. But for a basal cell, it’s the hedgehog pathway. And so, in the hedgehog pathway, there are certain types of mutations specifically associated with that pathway. And one of them, among these mutations, we look for drugs that can inhibit this pathway. So, there are drugs that specifically target the hedgehog pathway.  

They’re called hedgehog inhibitors, and they’re oral medications or pills that you can take every day. And those are for patients with basal cell skin cancer, because the basal cell skin cancer came about because the hedgehog pathway is not normal. But for squamous cell skin cancer, squamous cell skin cancer often has a lot of mutations. And unfortunately, they’re the type of mutations that we actually don’t have a drug for at this moment. But one unique thing about squamous cell skin cancer is that it has so many mutations.  

And so, that means that it has a better chance of responding to a different type of treatment. It’s an IV treatment known as immunotherapy. And so, that’s something that’s relatively recent, I think, in the past five years now. We’ve started using immunotherapy for patients that have squamous cells skin cancer, and it’s worked remarkably well.  

Katherine:

How do these cancers typically progress? What are the stages?  

Dr. Park:

Yeah, so, if it’s just a really small cancer like that’s on your face, it’s typically an early stage or a stage I. And I’m specifically talking about squamous cell skin cancer, because actually for basal cell, we don’t have any formal staging for basal cell.  

Katherine:

Why is that? 

Dr. Park:

It just wasn’t included in the staging systems. So, for basal cell, there’s no formal staging criteria, but we’ll stage it as early stage based on what we think, as a clinician, when we see you; or if we get imaging and we see that it’s spread to other areas, it may be later stage. But for squamous cell skin cancer, it’s earlier stage depending on the size. Sometimes when we get a biopsy, and in the biopsy, if we find high risk things in the biopsy, that may actually put you at a higher stage, even if the cancer is somewhat small.  

So, that could be like a stage III. But if at any point we find on imaging that the cancer has spread elsewhere – so, like you have a cancer that has spread to your liver, or to your lungs, or to the bones in your body, that’s a stage IV. 

Katherine:

Okay. And when is the cancer considered advanced? 

Dr. Park:

I think the cancer would be considered advanced if it’s not something that a surgeon can simply just remove. So, the dermatologist cannot just do a standard Mohs surgery, or the head-and-neck surgeon cannot just do a standard surgery, because advanced means that the cancer is either pretty deep, pretty large; or the surgeon can do surgery, but that means that the surgery would be very disfiguring. Sometimes these lesions can be really big on the face. 

And sure, the surgeon could do the surgery, but if we have to take part of your eye, or part of your nose or your ear, and you have to have major reconstruction, that’s considered probably more of an advanced tumor.   

Katherine:

Okay. As I mentioned, in this webinar, we’re focusing on advanced cancer. So, what is the typical treatment path for someone who’s been diagnosed at this stage of disease, at the advanced stage?  

Dr. Park:

Yeah, so, before – and I really love this question, because in the past, we did not have that much to offer patients except surgery, and then they would get a very extensive surgery. They would get reconstruction. But sometimes it’s hard to get reconstruction after a really major surgery, because you have to heal, and you have to get better. And then, after the surgery, you would typically get radiation to try to prevent the cancer from coming back. But nowadays, we have immune therapy.  

So, immune therapy is a certain type of IV medicine that’s not chemotherapy that works really well for squamous cell skin cancer. And so, nowadays, we can actually give this to you before surgery. So, we can give you a couple of doses of this IV immune therapy medicine before surgery, and really shrink your tumor quite dramatically.  

And then, that makes the surgery a lot easier, smaller. And then, sometimes after we do the surgery, and then we look at what the surgeon has taken out under the microscope, we can’t see any tumor left. And that’s really amazing, because then sometimes we don’t even need to do radiation. So, not only did we make your tumor a lot smaller, sometimes we completely made it go away.   

And then, if that happens, sometimes we don’t even need to do radiation. So, it really helps the patient. And I think this is really important, because this is somewhat newer data, and I still see patients that get referred to me for just surgery. 

But I think a lot of head and neck surgeons are now aware of this data. And so, this is something that’s, I think, becoming more common.  

Katherine:

What about targeted therapies?  

Dr. Park:

So, targeted therapies are, I think, mainly used in basal cell skin cancer. So, targeted therapies are typically oral medications or pills. They’re called targeted, because they’re used in cancers that have a specific target. So, for example, the basal cell skin cancer, the target is the hedgehog pathway, because the hedgehog pathway is abnormal. And so, these pills, they specifically target the hedgehog pathway. But for squamous cell skin cancer, we don’t have any true targeted therapies.  

Katherine:

As patients are reviewing their options with their doctor, what questions should they be asking about their care plan? 

Dr. Park:

I think all patients should be asking, what the goal of the treatment is. They should be asking, especially if they’re being offered any type of treatment, what are the side effects? What can I expect from this, in terms of how much better will it make me? They should really ask about how often the treatments are given, because some patients have transportation issues or financial barriers, and we want to know about that, so we can help them.   

Patients should also ask about any necessary blood work that is needed. They should ask what can they do in the future to prevent a similar type of cancer happening, and just make sure that they’re talking to their families, because I think social support is really important.  

Katherine:

Yeah. I think it’s important for patients to ask how the cancer is going to impact their lives overall, really.  

Dr. Park:

Yeah, exactly, because it will affect every single aspect of your life: your social life, your family life, your mental health, your physical well-being. And so, it’s really important to know and work with your doctor on what you think you can expect now, and also in the future.  

Katherine:

Yeah. Well, how do test results impact treatment options, then? 

Dr. Park:

So, there are sometimes when we have a skin cancer that actually happens inside a gland in your face. It’s one of the salivary glands in your face. And we sometimes don’t know if it’s a skin cancer that happened on the outside and that spread to the gland inside your face, or did it actually first just start inside the gland? Because a cancer that just starts inside the gland is not technically a skin cancer. It’s a different type of head-and-neck cancer, and it’s very, very rare, and it’s treated very differently.  

So, nowadays, because we have that molecular testing, like I talked about, I see lots of patients where they have a cancer in their salivary or parotid gland. We don’t know where it came from. And so, we send it for molecular sequencing or molecular testing, and there are certain clues in the molecular testing that can tell us, oh, it probably actually came from a skin cancer.  

You just didn’t know it; or maybe it’s the skin cancer that kind of was there and went away; or maybe it was a skin cancer you had like five years ago, that you didn’t think caused any problems, but it did spread, because knowing where it came from through molecular sequencing, if it’s really hard to find out where, really impacts the treatment I may give you.  

Katherine:

Dr. Park, we’ve been hearing a lot about innovation technology, or we’ve been hearing a lot about innovations in technology. How are these advances improving skin cancer care?  

Dr. Park:

They’re approving care, because we can offer patients more minimal procedures. We can tell them you don’t need this type of other treatment, and you can have the same outcome. So, we can tell you need less treatment, and the outcomes are just as good, because sometimes more treatment is not always better. More treatment sometimes means more toxicity, more time away from family, more time away from home. Advances mean that we can keep you cancer-free for longer.  

Or even if I can’t ever get rid of the cancer, we have drugs that can keep it under control for a long time, and it stays under control, even if I stop the medicine. So, all those are really remarkable things for our patients, that we have options that can help them live healthy, full lives.  

Katherine:

How do you know if a treatment is working? How is a patient’s response monitored?  

Dr. Park:

For skin cancer, that’s pretty easy, and I think that’s one of the most satisfying things, because I can often see the cancer visibly. I don’t always have to rely on a scan, as for some patients for the cancers in their stomach or something like that. So, patients will often see a dramatic reduction in the size of their tumor, sometimes even after the first treatment I give them. And not only can we tell by looking at them; eventually, I will get a scan to compare it to the scan they had it in the first place, and we see that the tumor has gotten a lot smaller.  

Katherine:

That’s good news. What about side effects of these therapies? How are they managed?  

Dr. Park:

Yeah, so, for immunotherapy, there’s one specific side effect that we don’t find with chemotherapy, and that’s really when your body’s own immune system kind of ends up attacking the other parts of your body. And so, it can cause inflammation of other organs. And so, for patients that experience that, it can be very mild, and it can be all the way to very severe, requiring a patient to go to the hospital.  

But in all cases, we just have to tell the immune system to quiet down a bit, because it’s attacking your body. And so, the way we do that is we give the patient steroids. And so, if it’s really mild, maybe you have like a small rash; maybe we can just give you a steroid cream, or maybe we have to give you a steroid pill. But sometimes, if it’s really severe, we have to tell you to go to the hospital so you can get steroids through your IV.  

Katherine:

Okay. Beyond what has been approved to treat advanced non-melanoma skin cancer, where do clinical trials fit in?  

Dr. Park:

Clinical trials are great, because they’re the reason why we have the drugs that we have today that are working so effectively. And so, I’m really fortunate to be at a center where we offer clinical trials for patients.  

Clinical trials always fit in at any point in the journey, as long as they fit your disease. So, most of the clinical trials we have are for patients that have advanced disease, not for early stage, because the early stage patients don’t really need it; because with just simple surgery, they tend to do really well, and their cancer doesn’t really ever come back and cause issues.  

But clinical trials are really important, because they’re the only way we can study a promising treatment option; see how well it works, and if it works really well, then move it further on to hopefully help a lot of other people. And that’s why we have immunotherapy today – is through clinical trials; and immunotherapy is used for lots of cancers. 

Katherine:

It is, yes. Are there barriers to accessing trials? And if so, do you have any recommendations on how to tackle them?  

Dr. Park:

Yeah, there are barriers to trials, and I think the thing that the cancer community is really trying to work on is barriers to accessing trials if you’re from an underrepresented population in medicine. So, based on your socioeconomic status, meaning how much money do you make or what your education level is, what race are you, what ethnicity, what is your background; because we know that there’s a disparity for those individuals. And so, I think really asking your doctor, staying curious; asking them, “Could a clinical trial help me?” 

Even if you have no idea of really what trials there are, or what they really mean, you can just throw that word out; and that then, the doctor knows that you’re potentially interested, and they can actually give you the information and help you learn more about it, even if you don’t know much about it; because I think it’s still quite a black box, and we’re trying to overcome this barrier, but it’s difficult.  

Katherine:

And what about researching clinical trials online? What sites would you recommend?  

Dr. Park:

So, I have to admit that there are multiple sites, but sometimes they are not very patient-friendly. Even whenever I look at them, they are not very friendly. I think the largest repository of clinical trials is the NCI database. It’s just where every clinical trial that’s open has to be registered, and it’s run by the federal government, I believe. And because it’s not super regulated, it’s just the person working on the trial entering information, and they’re typically of a medical background, sometimes the information is not very easy to digest or understand.  

So, I think really just letting your medical team know that you might be interested in a trial, then they can help you find the right trial for you. And if they don’t have one, they can tell you other areas or other centers that might have one. You are more than welcome to go search in Google and all that, but it can be really hard, and then I don’t want that to make the patient feel that this is not for them.  

Katherine:

Right, right. Are there any recent research highlights that you could share with the audience?  

Dr. Park:

Yeah, so, one thing that just recently came out is that – so, squamous cell skin cancer is actually a lot more common and a lot more aggressive in patients that have an organ transplant. So, I’m talking about patients that have a kidney transplant, or a liver transplant, or heart transplant.  

But the problem is, I can’t really give them immune therapy like I can somebody else that does not have a transplant, because like I said, sometimes one of the side effects of the immune therapy is that it can attack other parts of your body. And so, for patients that have an organ transplant, one of the risks, if I did give them immune therapy, is that it would actually attack their organ that they got from somebody else.  

And except for kidney, because we have dialysis: if I injure that organ, I don’t really have much else, and that does not bode well for the patient. But now, they’re trying to really figure out ways we can actually combine immune therapy with steroids in different doses to really see: can we actually help the patients that have organ transplants? Can we help their skin cancer? But then, can we also not injure their organ? And so, that’s something that a lot of research is being conducted on right now, and it’s really exciting.   

That’s great information. Well, Dr. Park, as we wrap up, what would you like to leave the audience with, in terms of the state of advanced non-melanoma cancer care?  

Dr. Park:

Yeah, I think as a patient, no matter your background, I think it’s just really important to be your own best advocate. And sometimes, that’s easier said than done. Some patients have families that can be advocates for them; but if you are by yourself, you can ask your doctor anything. You have the right to know, because it is your health and your body, and we do want to hear from you, because we do want to work with you to provide the best care that we can for you. 

Katherine:

Dr. Park, thanks so much for joining us today. I really appreciate it.  

Dr. Park:

Thanks so much, Katherine. It was a pleasure. 

Katherine:

And thank you to all of our collaborators. If you’d like to watch this webinar again, there will be a replay available soon. You’ll receive an email when it’s ready, and don’t forget to take the survey immediately following the webinar.  

It will help us as we plan future programs. To learn more about advanced non-melanoma skin cancer, and to access tools to help you become a more proactive patient, visit powerfulpatients.org. I’m Katherine Banwell. Thanks for being with us.