From the Guidelines
Treatment options for skin malignancy should be individualized based on the type, stage, and location of the cancer, with surgery being the most common treatment, as recommended by the most recent guidelines 1. The treatment of skin malignancy depends on several factors, including the type of cancer, its stage, and location.
- Surgery is the most common treatment, including excision, Mohs surgery, curettage and electrodesiccation, and cryosurgery.
- Radiation therapy is also used, particularly when surgery is not possible or for advanced cases.
- Topical medications, such as 5-fluorouracil, imiquimod, or ingenol mebutate, may be used for superficial cancers.
- Systemic treatments, including chemotherapy, targeted therapy, and immunotherapy, are also available, with options like pembrolizumab or nivolumab for melanoma, as outlined in recent guidelines 1.
- Photodynamic therapy is another option, combining light-sensitive drugs with light exposure to destroy cancer cells. The selection of treatment is based on cancer type, size, depth, location, and patient factors, with early detection and treatment significantly improving outcomes, as emphasized in recent studies 1. A dermatologist or oncologist should determine the most appropriate treatment plan for each individual case, taking into account the latest evidence and guidelines 1.
From the FDA Drug Label
The application frequency for Imiquimod Cream is different for each indication. Imiquimod Cream should be applied 2 times per week for a full 16 weeks to a defined treatment area on the face or scalp (but not both concurrently). Imiquimod Cream should be applied 5 times per week for a full 6 weeks to a biopsy-confirmed superficial basal cell carcinoma.
Treatment options for skin malignancy include:
- Imiquimod Cream for actinic keratosis and superficial basal cell carcinoma
- The cream should be applied as directed by the prescriber, with the frequency and duration of application depending on the specific indication
- Patients should be monitored for local skin reactions and other adverse effects, and the treatment plan should be adjusted as needed 2
- Vemurafenib is also an option, but it is associated with risks of new primary cutaneous malignancies, non-cutaneous squamous cell carcinoma, and other malignancies, and requires regular dermatologic evaluations and monitoring for signs of other malignancies 3
From the Research
Treatment Options for Skin Malignancy
The treatment options for skin malignancy, specifically melanoma, have evolved over the years with the introduction of immunotherapies such as pembrolizumab and nivolumab.
- Pembrolizumab and nivolumab are anti-PD-1 agents that have shown efficacy in the treatment of advanced melanoma 4, 5, 6, 7, 8.
- These agents work by binding to the PD-1 receptor and preventing its interaction with its ligands, allowing for an increased immune response and potentially increased anticancer immune activity 7.
- Clinical trials have demonstrated that pembrolizumab and nivolumab have comparable safety and efficacy profiles, with objective response rates of 26-38% and 31-40%, respectively 5, 6, 7.
- The choice of treatment between pembrolizumab and nivolumab should be based on patient and clinician preference, as there is no significant difference in overall survival between the two treatments 5, 6.
Adjuvant Treatment for High-Risk Melanoma
- Pembrolizumab has been approved for the adjuvant treatment of high-risk, resected melanoma, and has shown efficacy in reducing the risk of recurrence 4.
- The use of pembrolizumab in the adjuvant setting has become a standard of care for patients with resected stage III or IV melanoma 4.
- Nivolumab has also been shown to be effective in the adjuvant treatment of high-risk melanoma, with comparable efficacy to pembrolizumab 5, 6.
Management of Immune-Related Adverse Events
- Immune-related adverse events (irAEs) are a common side effect of pembrolizumab and nivolumab treatment, and can be managed with treatment interruption or supportive care 5, 7, 8.
- Guidelines have been published for the management of irAEs, and clinicians should be aware of these guidelines when treating patients with pembrolizumab or nivolumab 8.