Although the increasing incidence of skin cancer has concerned
dermatologists for years, the true magnitude of this
epidemic has recently come into focus. In 2006, more than 3.5
million new cases of nonmelanoma skin cancer were diagnosed
in the United States, with the estimated cost of treatment in the
Medicare population over $400 million dollars per year.1,2 In
addition, large increases in skin cancer incidence were noted in
Canada, Northern Ireland, Scotland, and the Netherlands.
Given these trends, physicians treating skin cancer must identify
tumors at low and high risk for recurrence and metastasis, and
be familiar with available treatment options, including newer
therapeutic alternatives. In this issue of Seminars in Cutaneous
Medicine and Surgery, experts in the field focus on recent developments
in cutaneous oncology, providing us with a comprehensive
look at current and future trends affecting skin cancer
patients and their physicians.
As the number of patients affected by skin cancer
continues to increase, efforts to prevent ultraviolet (UV)
radiation-induced tumors have intensified. New chemopreventive
agents targeting stages of skin cancer development,
or reversing UV-induced immune suppression, are
being extensively studied. When used in conjunction with
traditional sunscreens, these agents may provide enhanced
protection against the harmful effects of UV radiation.
Drs Camp and Elmets provide a framework for understanding
how these agents work and under what
circumstances they could prove most useful. Another hot
topic is whether lasers or topical treatments can effectively
treat nonmelanoma skin cancer, thereby providing an alternative
to the more traditional modalities of surgery and
radiation. Drs Brightman, Warycha, Anolik, and Geronemus
review the data regarding these alternative strategies,
which could benefit patients who have numerous small,
superficial tumors, or who are reluctant to undergo surgery.
To optimize patient care, it is critical to identify skin cancer
patients at risk for poor outcomes and standardize the classification,
staging, and treatment of high-risk tumors. Drs LeBoeuf
and Schmults summarize the National Comprehensive Cancer
Network’s treatment guidelines for classification and management
of high risk cutaneous squamus cell carcinoma, as well as
the American Joint Committee on Cancer staging guidelines.
The development of reliable prognostic models and validated
staging systems for this tumor will facilitate the design of clinical
studies and will ultimately guide future treatment decisions for
affected patients.
The most common post-transplant malignancy for immunosuppressed
organ transplant recipients is skin cancer.
Drs Singh and Brewer review the management alternatives
for organ transplant recipients affected by skin
cancer, including surgery, adjuvant radiation, and chemotherapy,
as well as options for chemoprophylaxis and reduction
of immunosuppression. Also addressed are special
considerations, including the approach to patients
with regional and distant metastatic disease, and management
issues in patients with multiple primary nonmelanoma
skin cancers and melanoma.
Merkel cell carcinoma is an unusual, aggressive cutaneous
tumor, seen more frequently in immunosuppressed
patients, whose incidence is also increasing. It was recently
found to be associated with a novel doublestranded
DNA virus, the Merkel cell polyoma virus, a discovery
that has sparked great interest in viral tumorigenesis.
Drs Wang, Byrne, Jacobs, and Taube discuss new developments
in the diagnosis, staging, and management of
Merkel cell carcinoma , and provide an update on current
thinking regarding the pathogenesis of this rare tumor.
An increasingly attractive option for patients with aggressive
or advanced nonmelanoma skin cancer is targeted
molecular therapy. The new generation of targeted molecular
inhibitors provides hope for a subpopulation of patients
with advanced skin cancer, potentially enhancing
their quality of life as well as their life expectancy. Drs
O’Bryan and Ratner provide an overview of recent developments
and future possibilities for treatment of unresectable or metastatic
squamous cell carcinoma, basal cell carcinoma,
and dermatfibrosarcoma protuberans.
We are grateful to the authors for sharing their expertise
and knowledge with us for this special issue. It is through
educational, clinical, and research efforts like theirs that
the morbidity, mortality, and cost of the skin cancer epidemic
will eventually be mitigated.