Indications

Non-Melanoma Skin Cancer (NMSC)

Risks & Prevalence

Skin cancer is a prevalent and potentially life-threatening disease that affects millions of people each year. Non-melanoma skin cancer (NMSC) comprises the two most common types of skin cancer: basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) (National Cancer Institute, 2023). BCC is the most frequent type of NMSC, accounting for 80% of all skin cancer cases, while melanoma is a less common but more aggressive form of skin cancer (Gupta et al., 2016; Rogers et al., 2015). Although NMSC is generally considered a low-risk cancer, it can have significant morbidity and, in rare cases, can be fatal (Rogers et al., 2015). 

Superficial BCC and Browen’s disease (SCC in situ) are subtypes of the most common NMSC and are located in the epidermis when diagnosed. Superficial BCC is the most common subtype of BCC, accounting for 20-30% of all BCC cases (Rigel et al., 2010). In the United States, the age-adjusted incidence rate of BCC per 100,000 person-tears was 236.1 for men and 156.9 for women’ according to a study (Rogers et al., 2015). Bowen’s disease is a relatively rare form of SCC in situ, accounting for less than 1% of all skin cancers (LeBoit et al., 2018). 

Treatment

Treatment options for non-melanoma skin cancer (NMSC), including basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), encompass various approaches such as surgical excision, radiation therapy, local chemotherapy with Efudex, pro-inflammatory drugs such as Imiquimod, immunotherapy utilizing immune checkpoint inhibitors targeting PD-1 and CTLA-4 receptors. Another treatment modality being explored for NMSC is phototherapy and photodynamic therapy (PDT) that involves applying a photosensitizing agent to the skin, which is then activated by light to destroy cancerous cells. FDA-approved photosensitizing agents for PDT include MAL (Metvixia) for superficial and nodular BCC and ALA (Luvilan kerastick) for actinic keratosis and superficial BCC (Wang et al., 2017; Liu et al., 2018)

National Cancer Institute. Skin Cancer. https://www.cancer.gov/types/skin. Accessed March 26, 2023.

Gupta A. K., & Paquet M. (2004). Network meta-analysis of the outcome ‘participant complete clearance’ in non-immunosuppressed individuals from eight treatments for actinic keratosis: a follow-up on a Cochrane review. British Journal of Dermatology, 151(5), 1099-1105.

Rogers H.W., Weinstock M.A., Feldman S.R., Coldiron B.M. Incidence estimate of non-melanoma skin cancer in the United States, 2006. Arch Dermatol. 2010;146(3):283-287.

Rigel D.S., Russak J,. Friedman R. The evolution of melanoma diagnosis: 25 years beyond the ABCDs. CA Cancer J Clin. 2010;60(5):301-316.

LeBoit P.E., Burg G., Weedon D., Sarasin A. World Health Organization Classification of Tumours: Pathology and Genetics of Skin Tumours. IARC Press: Lyon, 2018.

Wang K., Xu X.L., Wu Y., Wang X.L., Liu J., Jia Y., et al. Efficacy and safety of 5-aminolevulinic acid photodynamic therapy in the treatment of basal cell carcinoma: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed. 2017;33(5):270-276.

Liu J., Lu Y., Li X., Li T., Li C., Li C., et al. Efficacy of 5-aminolevulinic acid-mediated photodynamic therapy in the treatment of cutaneous squamous cell carcinoma: a systematic review and meta-analysis. Photodermatol Photoimmunol Photomed. 2018;34(5):243-251.

Actinic keratosis (AK)​

Risks & Appearance

AK is a common skin condition that develops because of prolonged exposure to sunlight or ultraviolet (UV) radiation, and it is also known as solar keratosis or senile keratosis. AK usually appears as rough, scaly patches on the skin, commonly on the face, scalp, neck, hands, and forearms. The patches can vary in size and color, ranging from red to brown, pink, or flesh colored. They may also be tender to the touch or cause itching. Although AK is not cancerous, it is considered a precancerous condition because if left untreated, it can develop into squamous cell carcinoma (SCC), a type of skin cancer Werner et al, 2013; Stockfleth et al, 2015; Berman et al, 2018).

Diagnosis

AK is usually diagnosed through a skin examination by a healthcare professional, such as a dermatologist. Dermatologists use a variety of methods to differentiate AK from other skin conditions. They may examine the lesion using a dermatoscope, and they may also perform a skin biopsy. Additionally, the dermatologist may use a technique called “blanching,” which involves pressing on the lesion to see if it turns white, which can be a sign of AK (Gupta et al, 2004; Schmitt et al, 2012). On visual examination, the AK lesions are keratotic, of variable thickness, poorly delimited, with a diameter of 1 cm or less, a variable degree of erythema, and sometimes pigmented (Dréno et al, 2014).

Treatment

The treatment options for AK depend on lesion severity, location, and patient health. Common approaches include topical medications (e.g., 5-fluorouracil, imiquimod), cryotherapy, curettage and desiccation, PDT, and chemical peels (Dréno et al, 2014; Reinehr & Bakos, 2019).

Dréno B, Amici JM, Basset-Seguin N, Cribier B, Claudel JP, & Richard MA; AKTeam™ (2014) Management of actinic keratosis: a practical report and treatment algorithm from AKTeam™ expert clinicians. J Eur Acad Dermatol Venereol.28(9):1141-9.

Reinehr CPH & Bakos RM. (2019). Actinic keratoses: review of clinical, dermoscopic, and therapeutic aspects. An Bras Dermatol.  94(6): 637–657.

Werner R. N., Sammain A., Erdmann R., Hartmann V., Stockfleth E., & Nast A. (2013). The natural history of actinic keratosis: a systematic review. British Journal of Dermatology, 169(3), 502-518.

Stockfleth, E., & Ferrándiz, C. (2015). Epidemiology and Risk Factors of Cutaneous Squamous Cell Carcinoma: Current Perspectives. Journal of Clinical and Experimental Dermatology Research, 6(5), 1-8.

Berman, B., Cohen, D. E., Amini, S., & Leonardi, C. (2018). Actinic keratosis: a review of the current literature. International Journal of Dermatology, 57(6), 633-644.

Gupta A. K., & Paquet M. (2004). Network meta-analysis of the outcome ‘participant complete clearance’ in non-immunosuppressed individuals from eight treatments for actinic keratosis: a follow-up on a Cochrane review. British Journal of Dermatology, 151(5), 1099-1105.

Schmitt, A. R., Brewer, J. D., Bordeaux, J. S., Baum, C. L., & Storan, E. R. (2012). Management of actinic keratosis: a practical approach. Journal of the American Academy of Dermatology, 68(1), e1-e14.

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