Nonsurgical Approaches to Keratinocyte Carcinomas

On the third day of Fall Dermatology Week 2023, Emily Ruiz, MD, MPH, discussed the use of nonsurgical treatments for skin cancer and how physicians can implement them in their practice during her session, “Nonsurgical Treatments for Skin Cancer.”

Dr Ruiz started with introducing the objectives of her presentation:

• To identify keratinocyte carcinomas that may benefit from nonsurgical treatments.
• To understand the different nonsurgical treatments available for keratinocyte carcinomas.
• To discuss implementation of nonsurgical treatments in the management of keratinocyte carcinomas.

Regarding the use of nonsurgical treatments, Dr Ruiz stated, “You can think about it both in early cancers as well as advanced cancers. And it's also important to think about it for patients with multiple skin cancers, but there is a middle zone where invasive cancers should just be treated surgically because that is the gold standard.”

She continued by introducing a list of treatments generally used, including radiation. However, she stressed that she does not typically recommend radiation for low-risk keratinocyte carcinomas.

“I'll reserve it for more aggressive tumors or in the adjuvant setting,” she stated, adding that the National Comprehensive Cancer Network guidelines point to radiation as an option for nonsurgical candidates or after positive margins when re-excision is not feasible.

“But what I'll mention is that I really don't think for low-risk squamous cells or basal cells, surgery isn't usually feasible,” she noted.

She transitioned to systemic therapies, starting with the oral chemotherapy agent capecitabine, which is a pro-drug of fluorouracil that blocks DNA synthesis.

“I use it in my practice for patients with field cancerization. So diffuse actinic damage with multiple low-risk squamous cells,” she stated. “In terms of published data, it really is limited, but there are some publications in renal transplant recipients.”

She added that it does require laboratory monitoring, and it is a good idea to check a dihydropyrimidine dehydrogenase enzyme, if possible, as it is involved in the degradation of 5-fluorouracil. She also mentioned a few caveats to capecitabine, noting that the response is not as good as topical therapy, and it typically is not covered by insurance.

However, she finalized her presentation by sharing that patients love capecitabine because they have no adverse reactions for the most part.

“And then you often can add on the topical therapy, especially after they do their 6 to 8 months, if they take a few months off, that's a good time to actually treat them topically,” she concluded.

For more meeting coverage, visit the Fall Dermatology Week 2023.

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Reference
Ruiz E. Nonsurgical treatments for skin cancer. Presented at: Dermatology Week 2023; September 20-23, 2023; Virtual.