Tag Archive for: skin cancer

Advice for Accessing Advanced Non-Melanoma Skin Cancer Clinical Trials

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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

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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

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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?

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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

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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

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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?

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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 Resource Guide

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Advanced Non-Melanoma Skin Cancer: What Do You Need to Know About Evolving Treatment and Research Resource Guide

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Dr. Silvina Pugliese: Why Is It Important for You to Empower Patients?

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Dr. Silvina Pugliese: Why Is It Important for You to Empower Patients? from Patient Empowerment Network on Vimeo.

How can skin cancer care providers work to empower their patients? Expert Dr. Silvina Pugliese from Stanford Cancer Center discusses her approach to patient empowerment, healthcare professionals she partners with, and methods to help enable informed patient decisions.

See More from Empowering Providers to Empower Patients (EPEP)

Related Resources:

Dr. Nizar Tannir: Why Is It Important for You to Empower Patients?

 Dr. Ebony Hoskins: Why Is It Important for You to Empower Patients?

 Dr. Ana Maria Lopez Why Is It Important for You to Empower Patients

Dr. Ana Maria Lopez Why Is It Important for You to Empower Patients

Transcript:

Dr. Pugliese:

I do think it is a great honor to care for patients, and I do think of it as my duty to empower patients or the way I think about it, to inform patients and allow them to come to their own conclusions and decisions based on the information that I provide. So the ways that I go about doing this are, first, I think it’s really important to establish a relationship with patients. I don’t have the fastest clinic visits, but I know a lot about my patients and they know a lot about me, and I do think that that relationship is a really important foundation for the trust that is needed in order to have a very secure patient-and-doctor relationship.

As part of that, I do listen to what patient concerns are, because I think that if we don’t identify what patients are fearful of, what they actually are very comfortable doing, if we don’t hear what their concerns are with certain treatments, then I think all the education that we do is really not going to be helpful if it doesn’t align with the patient’s treatment wishes and desires and what they’re comfortable doing. And then I provide information. So basically I will provide as much information as I have and know and always connect patients with someone who knows more than I do in their particular area of concern and who can provide information beyond what I know for certain situations. So often I will partner with other dermatologists, surgical dermatology, oncology, radiation oncology, medical oncology, surgical oncology, just to make sure that I have resources available for patients when they are making a decision.

So by doing those different things, I hope that I’m empowering my patients to feel better about their medical care, to feel like they are receiving the best medical care and to feel comfortable in making some really difficult decisions. It is important for me to do again, because I think that is my job, it’s my duty, I don’t take it for granted. And I think that it is the least that we can do when we’re being really entrusted with some very like vulnerable and personal information that patients are providing to us.

Becoming Empowered and [ACT]IVATED After A Non-Melanoma Skin Cancer Diagnosis

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Patient Empowerment Network (PEN) is committed to helping educate and empower patients and care partners in the non-melanoma skin cancer community. Skin cancer treatment options are ever-increasing with new testing, treatments, and research information, and it’s important for patients and families to educate themselves with health literacy tools and resources on the latest information in skin cancer care. With this goal in mind, PEN initiated the [ACT]IVATED Non-Melanoma Skin Cancer program, which aims to inform, empower, and engage patients to stay abreast of the latest in skin cancer care.

The [ACT]IVATED Non-Melanoma Skin Cancer (NMSC) program is geared to newly diagnosed skin cancer patients, yet can be beneficial for patients at any stage of disease and for patient advocates. [ACT]IVATED helps patients and care partners stay updated on the latest options for their skin cancer, provides patient activation tools to help overcome barriers to accessing care and powerful tips for self-advocacy, coping, and living well with cancer.

Skin Cancer Disparities

There are important skin cancer risk factors and vital differences to know about how some skin cancers can look and where they occur in different populations. Mary Leer, a cancer survivor and empowerment lead at PEN interviewed Dr. Silvina Pugliese as part of the [ACT]IVATED Non-Melanoma Skin Cancer program. Dr. Pugliese discussed some skin cancer risks including occupational risks of those who work outdoors, at high altitudes like pilots and Air Force personnel or veterans, and older white men. Additional risk factors include those who have undergone solid organ transplant, arsenic in well water, smoking, chronic wounds, wounds or scars, genetic mutations, exposure to radiation, leukemia patients, living near the equator, freckles, and naturally blonde or red hair. Dr. Pugliese further shared about current or previous occupational risks, “…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.”

The appearance of basal cell skin cancer and squamous cell skin cancer may often look different or occur in different locations in skin of color patients in comparison to white patients. It’s important for both patients and patient advocates to raise awareness about the key differences. Dr. Pugliese explained how more studies on squamous cell cancers have shown how locations may vary for non-white patients. “…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 also important to note that squamous cell cancers are often advanced when they’re diagnosed, and so larger sections of skin are more often removed, which may have more long-term impact on the patient.

Basal cell cancer is the most common type of skin cancer and has a different appearance in skin of color patients. Dr. Pugliese explained the key differences in appearance and a rare tumor called Dermatofibrosarcoma protuberans (DFSP). “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.”

Dr. Pugliese [ACT]IVATION Tip

Solutions for Improved Skin Cancer Care

Patient education and empowerment are key parts on the path to informed and optimal care. These efforts can take many forms but include approaches like improving clinical trial participation, learning more from credible resources, asking questions to ensure your best care, and helping to educate others about skin cancer.

Clinical trial participation by diverse populations is especially important for the more rare types of skin cancer. Dr. Silvina Pugliese shared about the value that can be derived from research, “…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.”

[ACT]IVATED Non-Melanoma Skin Cancer Program Resources

The [ACT]IVATED Non-Melanoma Skin Cancer program series takes a three-part approach to inform, empower, and engage both the overall lung cancer community and patient groups who experience health disparities. The series includes the following resources:

Though there are skin cancer disparities and variation in location and appearance of skin cancer, patients and care partners can be proactive in gaining knowledge to help ensure optimal care. We hope you can benefit from these valuable resources to aid in your skin cancer care for yourself or for your loved one.

[ACT]IVATION Tip:

By texting EMPOWER to +1-833-213-6657, you can receive personalized support from PENs Empowerment Leads. Whether you’re a non-melanoma skin cancer patient, or caring for someone who is, PEN’s Empowerment Leads will be here for you at every step of your journey.

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

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

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An Expert’s Perspective on Advanced Non-Melanoma Skin Cancer Research from Patient Empowerment Network on Vimeo.

What’s the latest in advanced non-melanoma skin cancer research? Dr. Sunandana Chandra shares an update on emerging treatments and provides reliable resources for research news.

Dr. Sunandana Chandra is a medical oncologist and Associate Professor of Medicine at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Learn more about Dr. Chandra.

Katherine:

Are there developments in advanced non-melanoma skin cancer treatment and research that patients should know about? 

Dr. Chandra:

So, you know, in the past, as a medical oncologist, we used to use a lot of chemotherapy.  

So, these are drugs that are notoriously hard to tolerate. Patients, understandably, are fearful of them and many of them don’t want them. They’ve seen friends and family go through them. And frankly, they have not been the most effective or efficacious in treating non-melanoma skin cancers, traditionally. But in the past, that’s all we had.

Now, we actually have much better therapies, specifically, the category of drugs called immunotherapy drugs that really boost a person’s own immune system to fight the cancer. These drugs are fairly new in the cancer world, and certainly new in the non-melanoma skin cancer world, and so, many of our colleagues in the community may not necessarily think of them when they’re considering patients.  

Perhaps, a lot of our patients haven’t even gotten a chance to hear about them. So, yes. There are new developments that I think are worth considering earlier and earlier in the course of a person’s treatment course. And so, I think an earlier referral to these multidisciplinary team members, including a medical oncologist, may not be a bad idea. 

Katherine:

How can patients stay up-to-date on developing research? What’s available for them? 

Dr. Chandra:

So, you know there are skin cancer patient advocacy websites that they can check out, skincancer.org. I always tell patients to be careful about what website they’re checking, because I certainly want them to go to a website that’s reputable, that’s vetted, that is something that we think has accurate information that’s evidence-based.  

And so, AIM at Melanoma has a non-melanoma skin cancer educational website. It’s called SCERF, which is Skin Cancer Education and Research Foundation, and you can find that through the aimatmelanoma.org website. You can look at skincancers.org, you can try with American Cancer Society, or you can even ask your clinical care team and see if they have any suggestions. There’s a lot of resources out there. I would just urge our patients to be careful in what source they’re looking at just make sure that they’re getting accurate, evidence-based information.

Should Advanced Non-Melanoma Skin Cancer Patients See a Specialist?

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Should Advanced Non-Melanoma Skin Cancer Patients See a Specialist? from Patient Empowerment Network on Vimeo.

Do advanced non-melanoma skin cancer patients need to see a specialist? Dr. Sunandana Chandra explains the benefits of working with a specialist, how she empowers patients, and when she recommends seeking a second opinion.

Dr. Sunandana Chandra is a medical oncologist and Associate Professor of Medicine at Robert H. Lurie Comprehensive Cancer Center of Northwestern University. Learn more about Dr. Chandra.

Katherine:  

Why is it important that patients speak up and have a voice in their care? 

Dr. Chandra:  

Well, I think for person to feel empowered, they have to understand their cancer, in my opinion. 

And that’s part of my responsibility is to try to share what I know about their cancer, my medical and clinical experience dealing with that type of cancer, and really, to try to empower them by giving them knowledge about their cancer, about their diagnosis, about the prognosis, about potential treatment options. And, I really think that that knowledge is really empowering for our patients and their family members, and I think with that knowledge, they can make the most informed decision, and they can help us then figure out what the best management plan for them is. You know, I try to spend a considerable amount of time with my patients and their family members and loved ones to explain all of this at the get-go so that that way, oftentimes, they can go home, they can kind of think about it, come back with more questions. 

Or, if they do some additional research on their own, hopefully some of what I’ve talked about might resonate and might even spur on more questions that usually can be very helpful for us to try to answer, helpful for the patient, I mean. 

Katherine:

Absolutely. Should patients consider seeing an advanced non-melanoma skin cancer specialist? 

Dr. Chandra:

You know, for a “routine” non-melanoma skin cancer of which the most common are basal cell carcinomas, squamous cell carcinomas, they may be tiny spots, maybe one, potentially multiple, that can just be excised and the person can be followed closely. For them, perhaps seeing someone locally, maybe very reasonable.   

But, if the patient themselves is ever worried or unsure, or they feel like they want to see a specialist, I absolutely would encourage that. In addition, for a person who has recurrent non-melanoma skin cancers, you know, multiple occurrences, maybe even more advanced than others, I think that those particular patients going to a specialist or a number of specialists may really help with the most advanced care. Maybe it’ll allow the patient and their team to be more proactive, maybe allow for other options that are maybe not standards of care, maybe novel, but promising.  

And so, I think for patients who are worried or for patients with more high-risk features, more increased number of skin cancers, perhaps more advanced skin cancers, I think having an expert or a team of experts on their team is certainly worth considering. 

Katherine:

What is your advice for patients who may feel like they’re hurting your feelings by seeking a specialist or a second opinion? Any advice for self-advocacy? 

Dr. Chandra:

Oh, gosh. I mean, I always tell our patients I strongly encourage it if they bring up especially. You know, I never want to patient of mine or their family members to look back and have any regrets. And so, from the get-go, I think that they should seek opinions. They should feel comfortable with the management that I or someone else is recommending to them.  

And, if a person asks me if it’s okay if they seek an opinion, I’m actually very encouraging of it because it doesn’t hurt my feelings. In fact, I think, again, it empowers the patient, which at the end of the day I think is most important and allows, hopefully, for them to have no regrets. And, I always tell patients more heads are better than one. So, if a colleague has another idea that perhaps I didn’t think of or vice versa, having that discussion and ultimately, that may allow for better patient care, which I think is all of our goals, which is actually our ultimate goal, I should say.