NON-MELANOMA SKIN CANCER
With the incidence of nonmelanoma skin cancer on the rise, current prevention methods,
such as the use of sunscreens, have yet to prove adequate to reverse this trend. There has
been considerable interest in identifying compounds that will inhibit or reverse the biochemical
changes required for skin cancers to develop, either by pharmacologic intervention
or by dietary manipulation. By targeting different pathways identified as important in
the pathogenesis of nonmelanoma skin cancers, a combination approach with multiple
agents or the addition of chemopreventative agents to topical sunscreens may offer the
potential for novel and synergistic therapies in treating nonmelanoma skin cancer.
Semin Cutan Med Surg 30:6-13 © 2011 Elsevier Inc. All rights reserved.
The incidence of nonmelanoma skin cancer (NMSC) continues to increase. Multiple reports
from the United States and Europe suggest we are in the midst of an epidemic. European
studies show substantial NMSC incidence increases during the last 2 decades. In the
United States, a recent analysis of Medicare Claims data showed that procedures performed
for NMSC nearly doubled from 1994 to 2006. From these data, the total number of
new NMSC in 2006 was estimated to be 3,507,693. Procedure data for 2006-2008 from the
5% Medicare Claims sample dataset corroborate the reported trajectory of incidence
increase. Destructions, excisions, and Mohs procedures for NMSC have increased by
2.6% per year during the last 2 years. On the basis of this current rate of increase, the
annual incidence of NMSC in the United States in 2008 would be nearly 3.69 million.
Recognizing the NMSC epidemic is critical as the incidence—and cost—will continue to
Semin Cutan Med Surg 30:3-5 © 2011 Elsevier Inc. All rights reserved.
Novel strategies are urgently needed to address the millions of nonmelanoma skin cancers
treated in the United States annually. The need is greatest for those patients who are poor
surgical candidates or those prone to numerous nonmelanoma skin cancers and therefore
at risk for marked disfigurement. Traditional treatment strategies include electrosurgery
with curettage, radiation therapy, cryotherapy, excision, and Mohs micrographic surgery.
Alternatives to traditional treatment, including topical medications and light or laser therapies,
are becoming popular; however, there are various degrees of efficacy among these
alternative tactics. These alternatives include topical retinoids, peels, 5-fluorouracil, imiquimod,
photodynamic therapy, and lasers. The purpose of this paper is to review the
available data regarding these alternative strategies and permit the reader to have a sense
of which therapies are reasonable options for care.
Semin Cutan Med Surg 30:14-25 © 2011 Elsevier Inc. All rights reserved.
Cutaneous squamous cell carcinoma (CSCC) is the second most common malignancy
occurring in white patients in the United States and incidence rates are increasing. While
the majority of the 87,000-760,000 cases that occur yearly in the U.S. are curable, 4%
develop lymph node metastases and 1.5% die from the disease. Given the frequency of
occurrence of CSCC, it is estimated to cause as many deaths yearly as melanoma, with the
majority occurring in patients with high risk tumors or in those at high risk for metastasis
due to a variety of host factors, most commonly systemic immunosuppression. There are
currently no standardized prognostic or treatment models to assist clinicians in most
effectively identifying and managing these patients. Identification of patients at risk for poor
outcomes as well as standardization regarding classification, staging, and treatment of
high-risk tumors is critical for optimizing patient care. In this article, available literature on
the classification and management of high risk CSCC is briefly summarized, emphasizing
Semin Cutan Med Surg 30:26-34 © 2011 Elsevier Inc. All rights reserved.
Approximately 225,000 people are living with organ transplants in the United States. Organ
transplant recipients have a greater risk of developing skin cancer, including basal cell
carcinoma, squamous cell carcinoma, and malignant melanoma, with an approximately 250
times greater incidence of squamous cell carcinoma in certain transplant recipients,
compared with the general population. Because skin cancers are the most common
posttransplant malignancy, the resultant morbidity and mortality in these high-risk patients
is quite significant.
Semin Cutan Med Surg 30:35-47 © 2011 Elsevier Inc. All rights reserved.