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    Skin cancer advances

    Technology, genetic profiling enhance diagnosis, treatment

     

    Treatments, old and new

    On the treatment front, for nonmelanoma skin cancer, clinicians are returning to superficial radiation therapy (SRT). “The advantages of SRT are that it is basically painless and you achieve a reasonably good cosmetic result in areas where surgery might leave a defect,” Dr. Rigel says. 

    The disadvantage of SRT, however, is that radiation scars worsen over time, “so you would minimize this approach with a young person,” Dr. Rigel says. “In most cases, treatment is reserved to those at least 60 years old. The scar will not be as impactful as for a younger person.”

    Hedgehog inhibitors for basal cell carcinomas also show promise. “These are drugs that attack a gene that is abnormal in 90% of basal cells,” Dr. Rigel says.

    Patients with tumors that are too large for surgery can first be given hedgehog inhibitors to shrink the tumor beforehand.

    “Although there are a lot of side effects with these drugs, they are a viable option for advanced tumors that are challenging to manage,” Dr. Rigel says.

    Targeted therapy is one of the greatest advances in melanoma because “each melanoma tends to have its own genetic profile and genetic mutation,” Dr. Rigel says.

    For instance, the BRAF mutation is present in about 60% of melanomas.

    “There are BRAF inhibitor drugs that attack tumors that have this mutation,” Dr. Rigel says.

    Similarly, nivolumab and pembrolizumab are two drugs in a new class of biologics that blocks programmed cell death protein 1 (PD-1).

    “What is particularly exciting about this class of drugs is that after three years of use, the mortality curves appear to flatten, suggesting that we may be approaching a ‘cure’ for those surviving this therapy,” Dr. Rigel says.

    Disclosures: Dr. Rigel reports that he is a consultant and an investigator for Castle Biosciences Inc. and a board member of Sensus.

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