Tag Archive for: Non-Melanoma Skin Cancers

Non-Melanoma Skin Cancers and Clinical Trials | Advancing Science for Everyone

Non-Melanoma Skin Cancers and Clinical Trials: Advancing Science for Everyone from Patient Empowerment Network on Vimeo.

What is the value of non-melanoma skin cancer clinical trials? Expert Dr. Silvina Pugliese from explains why clinical trial participation is important and shares advice for patients.

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 are interested in participating in a clinical trial, in advancing medical knowledge, and you feel comfortable doing so, please ask your dermatologist or your oncologist, whether they’re aware of any clinical trials that are available for your particular type of skin cancer.”

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

Related Resources:

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

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

What Should Non-Melanoma Skin Cancer Patients Consider About Treatment?

What Should Non-Melanoma Skin Cancer Patients Consider About Treatment?

Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

What Is the Role of Immunotherapy for Non-Melanoma Skin Cancers?


Transcript:

Mary Leer:

Why is clinical trial participation so important in non-melanoma skin cancers, and what advice do you have for patients considering a clinical trial?

Dr. Silvina Pugliese:

This is a great question. So it is much more common to have early stage localized disease for basal cell cancer and squamous cell cancer. So the overall case number that we see for advanced or unresectable or metastatic disease for squamous cell cancer and especially for basal cell cancer is much lower than the usual numbers we hear of 4 million cases annually of basal cell cancer in the U.S., and 2 million of squamous cell cancer. And the reason this is important is because when we have a lower pool to evaluate or study, when we think about these more advanced skin cancers, we have less patients to recruit for some of these studies. This is especially important when we think about advanced or metastatic basal cell cancer, which is very rare.

Also very important we think about less common skin cancers like Merkel cell carcinoma or DFSP. And when we think about how uncommon these skin cancers can be in skin of color, we realize we’re really drawing from a very small pool of patients. So my point here is that you can make a true impact by enrolling in a clinical trial, especially as we’re looking at what are some of the best treatment options for these more advanced skin cancers or metastatic skin cancers? Because we do need the right patients to be enrolled in order to study these research questions.

So my activation tip is, if you are interested in participating in a clinical trial, in advancing medical knowledge, and you feel comfortable doing so, please ask your dermatologist or your oncologist, whether they’re aware of any clinical trials that are available for your particular type of skin cancer. Of course, never feel any pressure to do this, it’s completely optional, but often it can provide more, a novel treatment option for your cancer or allow you to have certain treatment that’s not available through insurance, for example, at the moment. And also in doing so, advance the knowledge that we have in our field and help patients in the future who have your same skin cancer and are in your same position. 


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What Should Non-Melanoma Skin Cancer Patients Consider About Treatment?

What Should Non-Melanoma Skin Cancer Patients Consider About Treatment? from Patient Empowerment Network on Vimeo.

What is vital for non-melanoma skin cancer patients to know about treatment decisions? Expert Dr. Silvina Pugliese from Stanford Cancer Center explains how she works with patients and shares advice for communicating with your doctor.

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

“…making sure that you have received all the information that you want, that you’ve received the opinions that you think are important for making that decision, and that you feel comfortable like you were able to make an informed decision.”

Download Guide  |  Download Guide en español

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

Related Resources:

Non-Melanoma Skin Cancers and Clinical Trials | Advancing Science for Everyone

Non-Melanoma Skin Cancers and Clinical Trials | Advancing Science for Everyone

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

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?


Transcript:

Mary Leer:

Dr. Pugliese, I’m curious, how do you work with your patients to make treatment decisions? And my curiosity in part is coming from, I have several family members that have had non-melanoma skin cancer, so I’m curious how you work with your patients and with the increase in treatment options, what should non-melanoma skin cancer patients consider when they’re deciding on a treatment?

Dr. Silvina Pugliese:

Those are great questions. So one of the first things that I do when working with patients to make any kind of treatment decision is, of course, first establish just a very open and trusting relationship where patients feel comfortable talking to me about what their concerns are with their skin cancer diagnosis and what their treatment preferences are because we could have all the information in the world, but it’s really not ideal to make a decision if we don’t know what a patient wants to do and what their fears are and what their questions are. So just having a really open and trusting relationship I think is an important foundation that we need before we can really counsel anyone on treatment decisions. And then the next component is really that knowledge piece. So presenting all the options that are available to me that I know of.

And, of course, always connecting patients when needed to other resources. I work very closely with other oncologists, with oncologists, I’m sorry, with other dermatologists, with oncologists, with radiation oncologists, with medical oncologists, with surgical oncologists because often the treatment for patients that have more advanced squamous cell cancer is going to be a multidisciplinary treatment, involving many different specialties.

So for that reason, it’s very important to make sure that I’m not only discussing the things that I can do in dermatology, but that I’m connecting patients to all of the available resources. I do provide my opinion when patients ask, but again it’s really about what patients want to do. And I do think that it’s a very personal decision. We think about treatment options for treating non-melanoma skin cancers.

So listening, establishing a good relationship, providing all of the available treatment options, and then just having a conversation and being available when questions arise. I find that some patients want the lowest risk of recurrence always, and other patients are more focused on side effects. So that is going to impact how we frame, we discuss the treatment options available.

The good news, I will say for most squamous cell cancer and basal cell cancer is that, again, the treatment options are going to be lower risk, so for most basal cell and squamous cell, we will discuss depending on the subtype, either using topical creams or doing surgical excision or doing Mohs surgery depending on the location, and then based on that, I would ask patients what their greatest concerns are, what their goals are, and what their clinical follow-up can be so that we make the best decision for patients.

So my activation tip for patients in terms of this question is to make sure that before making any kind of treatment decision, you feel comfortable asking questions, that you feel like all your answers have been addressed. You should never make a decision where you think you’re making it based on incomplete information, and, of course, we can never know the outcome, and we can’t know everything about everything.

But I think it is really important that you feel the most comfortable possible when you make a treatment decision, it is very impactful. So again, just making sure that you have received all the information that you want, that you’ve received the opinions that you think are important for making that decision, and that you feel comfortable like you were able to make an informed decision.


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What Is the Role of Immunotherapy for Non-Melanoma Skin Cancers?

What is the Role of 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

“…recognizing that immunotherapy can be utilized in certain cases when we consider a systemic treatment of cutaneous squamous cancer and basal cell cancer. As a whole, immunotherapy is not currently first line treatment, but utilized when there is a high risk tumor or whether it’s metastatic disease or where there is locally advanced disease.”

Download Guide  |  Download Guide en español

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

Related Resources:

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

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

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:  

Immunotherapy is used in non-melanoma skin cancers in certain specific scenarios. First, PD-1 is a receptor that inhibits the activity of a sub-type of T-cells, this inhibition inhibits the, controls I could say the immune response, which is helpful because in exuberant and immune response can sometimes contribute to auto-immunity. However, cancer cells can unfortunately hijack this mechanism to suppress an anti-tumor response. So the immunotherapy we will be discussing today are monoclonal antibodies against PD1, and they work by encouraging and an anti-tumor response. And before diving into immunotherapy and when it is used, I first want to say that for most cutaneous squamous cell cancers and most cutaneous basal cell cancers, which are very different entities, but most of them can be treated by surgical excision or mohs micrographic surgery. In certain subtypes of both types of tumors, they can even be treated by topical medications, including topical chemotherapy and topical immunotherapy, so the cases where we think about more aggressive treatments are usually higher risk and more advanced and also unable to be treated with surgery or the other modalities mentioned. So in the case of cutaneous squamous cell cancer, the two FDA-approved PD-1 inhibitors that are used for treatment of continuous squamous cell cancer are pembrolizumab (Keytruda) and cemiplimab (Libtayo), some scenarios in which these PD1 inhibitors can be used are in the treatment of locally advanced cutaneous squamous cell cancer, not curable by surgery or radiation, as well as metastatic cutaneous squamous cell cancer.

For basal cell cancer, the FDA-approved treatment is cemiplimab. This is utilized for patients who have locally advanced or metastatic basal cell cancer that was previously treated with a hedgehog inhibitor or whom a hedgehog inhibitor is not appropriate. I should mention that immunotherapy is currently not first-line treated for either cutaneous squamous cell cancer or cutaneous basal cell cancer. Now because I mentioned hedgehog inhibitors, I wanted to say that this is another systemic treatment option that is utilized for more aggressive, locally advanced or metastatic high-risk basal cell cancer. Hedgehog inhibitors work by inhibiting a receptor called smoothened, and this inhibition also inhibits tumor growth. And again, these hedgehog inhibitors are utilized for local high-risk basal cell cancer, there’s a positive margin after mohs micrographic surgery, residual cancer after multiple excisions and can be primary treatment if radiation or surgery is not possible due to the size of the tumor, these can also be utilized for locally advanced or metastatic basal cell cancer, which can’t be treated topically, surgically or with radiation, because those treatments would not be curative in those cases. The two FDA-approved hedgehog inhibitors are vismodegib and sonidegib, my activation tip for this section is recognizing that immunotherapy can be utilized in certain cases when we consider a systemic treatment of cutaneous squamous cancer and basal cell cancer. As a whole, immunotherapy is not currently first line treatment, but utilized when there is a high risk tumor or whether it’s metastatic disease or where there is locally advanced disease. 


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

Occupational Exposures and Non-Melanoma Skin Cancer: Understanding Risk Factors from Patient Empowerment Network on Vimeo.

Which non-melanoma skin cancer causes and risks are important to know? Expert Dr. Silvina Pugliese explains common risk factors and advice for patients who may need skin cancer checks.

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 are within one of these occupational categories where you work primarily outdoors or have worked primarily outdoors, have had sunburns while working outdoors, have worked at high altitude, it’s important to have your skin checked, to make sure that you have not developed any spots that could be worrisome for non-melanoma skin cancer.”

Download Guide  |  Download Guide en español

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

Related Resources:

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

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

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

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

Hopeful Outcomes In Immunotherapy for Non-Melanoma Skin Cancers

What Is the Role of Immunotherapy for Non-Melanoma Skin Cancers?


Transcript:

Mary Leer:

Dr. Pugliese, we always think about the sun being the main cause of skin cancers. Can you speak to the occupational exposures and the risk for non-melanoma skin cancer?

Dr. Silvina Pugliese:

Yes, absolutely. So, certainly we know that UV exposure is a huge risk factor for skin cancer. Exposure to UV or ultraviolet radiation leads to damage with…damage to DNA within the skin cells. And this damage can lead to different changes within the skin cells and ultimately to mutations that lead to uncontrolled growth, which causes a tumor or skin cancer to develop. So in addition to the role of UV, we know that there are certain occupational exposures. So closely tied to the role of UV is any job or occupation that takes place outdoors in the sun.

So, for example, any kind of farm work, farmers, migrant farm workers, construction personnel who are working outdoors, postal workers, lifeguards. The other important category of patients are our military personnel and veterans who are often in areas that are close to the equator, where their jobs involve outdoor work where there really isn’t the time and leisure to be applying sunscreen when there are other safety concerns.

When we think about the Air Force, we know there’s also a lot of UV exposure in that particular branch of the military, given high altitude with flying. And then we have a very important veteran population that we take care of in dermatology and many of those patients are in the risk factor demographic that we worry about with skin cancer, including patients who are of older age, who are white and who are male, which are all risk factors for developing non-melanoma skin cancers.

My activation tip for this question is that if you are within one of these occupational categories where you work primarily outdoors or have worked primarily outdoors, have had sunburns while working outdoors, have worked at high altitude, it’s important to have your skin checked, to make sure that you have not developed any spots that could be worrisome for non-melanoma skin cancer.


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

How Do Non-Melanoma Skin Cancers Impact Non-White Populations? from Patient Empowerment Network on Vimeo.

Do non-melanoma skin cancers occur differently in non-white populations? Expert Dr. Silvina Pugliese explains how the appearance and location of squamous cell cancer and basal cell cancer can vary in non-white patients.

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

“…recognize the disparate presentations of non-melanoma skin cancers in patients who are not white. So this includes pigmented basal cell cancers. So looking out not just for shiny red bumps, but also blue or purple bumps on the skin, making sure that patients know and also doctors know how to look within areas of wounds, chronic non-healing wounds and also scars and in different locations such as just…such as the genital skin and the perianal skin, as well as the lower legs where we might see squamous cell cancer in skin of color patients.”

Download Guide  |  Download Guide en español

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

Related Resources:

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

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

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

What Is the Role of Immunotherapy for Non-Melanoma Skin Cancers?


Transcript:

Mary Leer:

In more recent years, the incidence of cutaneous squamous cell carcinoma is increasing not only in non-Hispanic whites, but also in Hispanics and Asians. What are we learning about how non-melanoma skin cancers impact non-white populations?

Dr. Silvina Pugliese:

In dermatology, we’re certainly making a more concerted effort in recent years in studying squamous cell carcinoma in patients of all skin types. Most of our studies in the past were in white patients or lighter skin patients, but in recent years we’ve realized how important it’s to make sure that we know how non-melanoma skin cancers impact all patients, including our skin of color patients.

A few examples of how squamous cell cancer may impact non-white populations differently include where these skin cancers present. So, for example, squamous cell cancers may present in different locations on the body. So when we think about common squamous cell cancer locations, we think about areas exposed to a lot of UV, tops of the ears, the nose, et cetera.

We know that in skin of color patients we might see more of these skin cancers on the lower legs or on the feet or in genital or perianal skin. And that’s important, because we as dermatologists need to make sure that we’re examining all of these areas when we’re doing a full body skin exam.

In addition, about 20 to 40 percent of all squamous cell cancers diagnosed in Black patients are occurring within scars or areas of chronic inflammation such as wounds. It’s, therefore, really important for us to educate patients on the fact that these are areas that could be problematic in the future and need to be evaluated.

Other ways that squamous cell cancer impacts non-white populations is that patients may present…skin of color patients may present with more aggressive disease. There was one study looking at Mohs defect sizes, meaning when surgical procedures are done to remove a skin cancer, what’s left behind after skin cancer is moved is called the defect.

And because some of these skin cancers are more advanced, some of these squamous cell cancers, for example, are more advanced, they will have a larger area of skin removed, which as you can imagine really does impact how the skin heals the risk of scarring, the risk of having any longer term complications from that procedure.

There are a number of things that we can do better on the dermatology side in terms of educating patients about what to look for on their skin and also things that we can do about educating each other. And I’m talking about medical school and residency education in identifying skin cancer in skin of color patients.

Another thing I did want to mention is that basal cell cancer, which is our most common type of skin cancer, has a very different look in patients with skin of color. So it might have more of a purple or blue appearance than the classic pink shiny bump that we talk about. And then finally there is a rare tumor that we call DFSP that is actually more likely to occur in Black patients and can often have a scar-like appearance. This is a rare soft tissue tumor that can involve the deeper skin sometimes into the fat and even muscle.

And patients with skin of color are more likely to present with larger tumors.  So my activation tip for this question is to recognize the disparate presentations of non-melanoma skin cancers in patients who are not white. So this includes pigmented basal cell cancers.

So looking out not just for shiny red bumps, but also blue or purple bumps on the skin, making sure that patients know and also doctors know how to look within areas of wounds, chronic non-healing wounds and also scars and in different locations such as just…such as the genital skin and the perianal skin, as well as the lower legs where we might see squamous cell cancer in skin of color patients. So overall I think education all around for our doctors and our patients will help our skin of color patients have their skin cancers, their non-melanoma skin cancers diagnosed more properly. 


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Which Non-Melanoma Skin Cancer Treatments Are Available for Patients?

Which Non-Melanoma Skin Cancer Treatments Are Available for Patients? from Patient Empowerment Network on Vimeo.

Which non-melanoma skin cancer treatments are available for patients? Expert Dr. Silvina Pugliese from Stanford Cancer Center 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

What Is the Role of 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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Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?

Non-Melanoma Skin Cancer Subtypes: Are Some Populations More At-Risk? from Patient Empowerment Network on Vimeo

Are some populations more at-risk for non-melanoma skin cancer subtypes? Expert Dr. Silvina Pugliese explains common subtypes, incidence rates, and risk factors linked with the subtypes.

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

Patients who have any of the risk factors discussed, so, for example, lighter-skinned, chronic sun exposure, and immunosuppressed for any reason, whether due to an underlying medical condition or a medication, or who have genetic mutations or history of radiation or any environmental factors that put them at risk, should be aware that looking at their skin for skin cancers is very important, and that they should see a doctor, a dermatologist, if they notice anything that looks suspicious on their skin, that warrants for their evaluation.”

Download Guide  |  Download Guide en español

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

Related Resources:

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In


Transcript:

Mary Leer:

All right. Dr. Pugliese, what are the various subtypes of non-melanoma skin cancers, and are certain populations more susceptible to getting non-melanoma skin cancers than others?

Dr. Silvina Pugliese:

So there are a number of subtypes of non-melanoma skin cancers. The most common one is called a basal cell cancer, that occurs in about 4 million, there are about 4 million cases of basal cell cancer in the United States every year, and it’s considered a skin cancer related to keratinocytes, the most common type of skin cell. The second most common type of non-melanoma skin cancer, is called a squamous cell cancer, also arising from keratinocytes with about 2 million cases diagnosed each year in the United States. There are also less common types of non-melanoma skin cancers, including Merkel cell carcinoma, which arises from Merkel cells and sebaceous carcinoma. 

When we think about risk factors, there are a number of risk factors that put certain populations at a higher risk of developing non-melanoma skin cancers. So, for example, one thing that we think about often is lighter skin. So patients who have blonde hair, red hair, freckles, who are more likely to sunburn, who have lighter skin, are going to be more prone to the UV damage that can cause some of these skin cancers to develop. Chronic sun exposure is closely interplayed with that concept, so patients that live in a warm climate, are closer to the equator, live at higher altitude, have outdoor hobbies or outdoor jobs. There are certain medications that can also confer a greater risk of developing non-melanoma skin cancers.

So medications that suppress your immune system or that making more sensitive to light or getting sunburns from UV. And any condition that suppresses the immune system. So, for example, patients that have undergone a solid organ transplant, like a heart transplant or a lung transplant, or patients that have a diagnosis such as chronic lymphocytic leukemia. We know that those patient populations are at much higher risk of developing non-melanoma cancers.

There are other factors that are environmental. So, for example, if there is arsenic in well water that is being bathed in, then that could also lead to development of squamous cell cancer, smoking, chronic wounds or scars can put certain patients at increased risk of squamous cell cancer, certain genetic mutations, and then a history of any radiation, for example, for the treatment of other types of cancer.

So my activation tip for this question is, there are a number of non-melanoma skin cancers that can present, the most common ones being basal cell cancer and squamous cell cancer. Patients who have any of the risk factors discussed, so, for example, lighter-skinned, chronic sun exposure, and immunosuppressed for any reason, whether due to an underlying medical condition or a medication, or who have genetic mutations or history of radiation or any environmental factors that put them at risk, should be aware that looking at their skin for skin cancers is very important, and that they should see a doctor, a dermatologist, if they notice anything that looks suspicious on their skin, that warrants for their evaluation.


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Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Explaining Skin Cancer to Newly Diagnosed Patients: An Oncodermatologist Weighs In from Patient Empowerment Network on Vimeo

How can skin cancer be explained to newly diagnosed patients? Expert Dr. Silvina Pugliese shares how she explains various skin cancer subtypes, the origin of different skin cancers, and how the incidence rate and appearance can differ for some non-melanoma skin cancers.

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

“…recognize that there are common non-melanoma skin cancers, which are also called keratinocyte carcinomas, they are called this because they arise from keratinocytes. The most common are basal cell skin cancers and squamous cell skin cancer, and it is important to recognize that they can look different from melanoma.”

Download Guide  |  Download Guide en español

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

Related Resources:

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?


Transcript:

Mary Leer:

Dr. Pugliese, how do you explain skin cancers to your newly diagnosed patients?

Dr. Silvina Pugliese:

So, when explaining skin cancers to my patients, I will, and this is in the context of explaining non-melanoma skin cancers, I will explain that they are cancers arising from different cells within the skin, so in the case of both basal cell cancer and squamous cell cancer, they arise from keratinocytes within the skin, and I’ll explain that the skin cancers are different from melanoma because many patients will have heard about melanoma, and I may know people who had melanoma, but they may know a little bit less about basal cell or squamous cell, despite those being the more common types of skin cancers.

I also will explain that basal cell and squamous cell are really the more common skin cancers that we encounter, so in the case of basal cell cancers, there are about 4 million cases diagnosed each year in the United States, and squamous cell cancer is the second most common kind of skin cancer with approximately 2 million cases diagnosed each year of squamous cell cancer.

My activation tip for this question is to recognize that there are common non-melanoma skin cancers, which are also called keratinocyte carcinomas, they are called this because they arise from keratinocytes. The most common are basal cell skin cancers and squamous cell skin cancer, and it is important to recognize that they can look different from melanoma.


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Melanoma vs. Non-Melanoma Skin Cancer: What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer: What’s the Difference? from Patient Empowerment Network on Vimeo.

 What’s the difference between non-melanoma skin cancer versus melanoma? Expert Dr. Silvina Pugliese defines the two major skin cancer types and explains skin cancer subtypes and their occurrence rates.

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

“…knowing that there are skin cancers that are separate and different from melanoma, and asking your doctor to take a look at your skin to see whether there’s anything suspicious for either a melanoma or a non-melanoma skin cancer, which could include basal cell cancer, squamous cell cancer, Merkel cell cancer, and sebaceous cell cancer among others.”

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Related Resources:

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?


Transcript:

Mary Leer:

Dr. Pugliese, what are non-melanoma skin cancers? I must admit I have some experience with skin cancer in terms of I’m a melanoma survivor, and my sister has had the non-melanoma skin cancers that we’re talking about.

Dr. Silvina Pugliese:

Thank you, Mary Leer. That’s a really great question. So it’s interesting that we think of non-melanoma and cancer that we name them in the context of melanoma being different from melanoma, because melanoma is a skin cancer that I think most people hear the most about, despite the other skin cancers that we’ll talk about, being more common. So melanoma, just to set the stage is a cancer, skin cancer, arising from melanocytes, and those are the cells in our skin that produce melanin, which provides color or pigment to our skin.

When we talk about non-melanoma skin cancers, we’re talking about cancers that are arising from different cell types, the most common non-melanoma skin cancers are those arising from keratinocytes, we call them keratinocyte carcinoma, and there are more common names are basal cell cancer and squamous cell cancer. Keratinocytes are the most common type of skin, so there are other less common non-melanoma skin cancers as well, some of those are, Merkel cell carcinoma, these developed from a cell called a Merkel cell, which are present in the skin.

They’re also called neuroendocrine cells because they produce certain hormones, and they can be involved in touch sensation, so basal carcinoma is another non-melanoma cancer that develops from sebaceous or oil glands, so you can see how the non-melanoma skin cancers are related to different cell types that we can find within the skin.

My activation tip for this question is knowing that there are skin cancers that are separate and different from melanoma, and asking your doctor to take a look at your skin to see whether there’s anything suspicious for either a melanoma or a non-melanoma skin cancer, which could include basal cell cancer, squamous cell cancer, Merkel cell cancer, and sebaceous cell cancer among others. 


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Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations?

Do Non-Melanoma Skin Cancers Differ in Diverse Patient Populations? from Patient Empowerment Network on Vimeo.

Can non-melanoma skin cancers vary in diverse patient populations? Expert Dr. Silvina Pugliese explains how the occurrence and treatment of squamous cell cancer and basal cell cancer can differ in diverse population groups and advice for patients to help ensure their best care.

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

“…be aware that some common skin cancers can present looking very different in skin of color patients. To know that skin of color patients can develop these skin cancers so that you feel empowered to ask your doctor to take a look at something and to really feel like you can advocate for yourself if you are worried about something, to ask for biopsy or just monitoring or whatever you feel most comfortable with so that we don’t allow some of these skin cancers to go undiagnosed for a longer period of time, unnecessarily.”

Download Guide  |  Download Guide en español

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

Related Resources:

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Melanoma vs. Non-Melanoma Skin Cancer | What’s the Difference?

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Explaining Skin Cancer to Newly Diagnosed Patients | An Oncodermatologist Weighs In

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?

Non-Melanoma Skin Cancer Subtypes | Are Some Populations More At-Risk?


Transcript:

Mary Leer:

Do non-melanoma skin cancers differ in a diverse patient population, and how does that difference if there is one, impact treatment?

Dr. Silvina Pugliese:

So there is a lot to talk about with this question. I think that one aspect of this question is the clinical appearance difference. And the answer is sometimes yes. So in certain patient populations, I’m talking primarily about skin of color currently, certain skin cancers like basal cell cancer can look different. They can have a more purple or blue appearance as opposed to the classic shiny pink red bump that you might hear about or be educated about. Another skin cancer presents a little bit differently in certain patients and specifically in a skin of color patients is squamous cell cancer. So there’s a higher likelihood of having a squamous cell cancer and in a chronic wound or on a scar in patients who are Black as opposed to lighter skin patients. And also, squamous cell cancer can present in different locations, like the genitals, perianal skin, or the lower legs. This is really important in terms of impacting treatment because you can imagine that if a lesion is not picked up early, the way something may be when it has a classic presentation, by the time that it’s diagnosed, it can be much larger or much more advanced. And this impacts treatment because that could mean a larger surgery, it could mean in certain cases needing to do treatments beyond surgery to completely get rid of the skin cancer.

But even just with surgery alone, having a larger surgery can cause a larger scar. It can cause some functional impairment after surgery, or it can even cause some other problems like impaired nerve sensation, for example. So it’s really important that we think about the different presentations of skin cancer across all skin types, and be mindful of both looking for those different kinds of skin cancers when we’re doing our skin checks as doctors, but also be really mindful of how can we educate all of our patients for what to look out for, because often our education is be mindful of sun-exposed areas, wear sunscreen, make sure that you’re looking at your ears and your nose and your face, but we’re not really educating about examining the genital area for skin cancer or being mindful of burns or being mindful of scars.

So my activation tip for this question is to be aware that some common skin cancers can present looking very different in skin of color patients. To know that skin of color patients can develop these skin cancers so that you feel empowered to ask your doctor to take a look at something and to really feel like you can advocate for yourself if you are worried about something, to ask for biopsy or just monitoring or whatever you feel most comfortable with so that we don’t allow some of these skin cancers to go undiagnosed for a longer period of time, unnecessarily.


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[ACT]IVATED Non-Melanoma Skin Cancer Resource Guide en español

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[ACT]IVATED Non-Melanoma Skin Cancer Resource Guide

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