What are examples of nonmelanoma and melanoma skin cancers and their treatments?

Types of Nonmelanoma and Melanoma Skin Cancers and Their Treatments

Nonmelanoma skin cancers include basal cell carcinoma and squamous cell carcinoma, while melanoma is a distinct and more aggressive form of skin cancer with higher mortality rates. 1

Nonmelanoma Skin Cancers

Basal Cell Carcinoma (BCC)

• Most common type of skin cancer (represents the majority of all nonmelanoma skin cancers)
• Characteristics: Rarely metastasizes but can cause substantial local destruction and disfigurement
• Treatment options:
  • Surgical approaches (gold standard with highest cure rates):
    • Mohs micrographic surgery (preferred for high-risk areas like face, genitals)
    • Standard surgical excision with 4mm margins
    • Curettage and electrodesiccation (best for non-hair bearing areas)
  • Non-surgical options:
    • Topical therapies (for superficial BCC):
      • Imiquimod 5% cream
      • 5-Fluorouracil
      • Photodynamic therapy
    • Radiation therapy (for non-surgical candidates)
    • Hedgehog pathway inhibitors (for advanced or metastatic BCC)

Squamous Cell Carcinoma (SCC)

• Second most common skin cancer
• Characteristics: Can metastasize, accounting for most NMSC-related deaths
• Treatment options:
  • Surgical approaches:
    • Mohs micrographic surgery (for high-risk tumors)
    • Standard surgical excision
    • Curettage and electrodesiccation (for low-risk tumors)
  • Non-surgical options:
    • Radiation therapy
    • Topical therapies (for superficial SCC/SCC in situ):
      • Imiquimod
      • 5-Fluorouracil
      • Photodynamic therapy (for Bowen's disease/SCC in situ)

Other Nonmelanoma Skin Cancers

• Merkel Cell Carcinoma:
  • Rare but aggressive cutaneous tumor
  • Higher mortality rate than melanoma
  • Treatment typically involves surgical excision with wide margins, sentinel lymph node biopsy, and often radiation therapy 1

Melanoma Skin Cancer

• Less common but more deadly than nonmelanoma skin cancers
• Characteristics: Higher mortality rates, can metastasize rapidly
• Detection: ABCDE rule (Asymmetry, Border irregularity, Color variation, Diameter >6mm, Evolution over time) 1
• Treatment options:
  • Surgical excision with appropriate margins based on tumor depth
  • Sentinel lymph node biopsy for staging
  • For advanced/metastatic disease:
    • Immunotherapy (PD-1 inhibitors like pembrolizumab 2 or nivolumab 3)
    • Targeted therapy (for tumors with specific mutations)
    • Radiation therapy
    • Combination therapies

Risk Factors for Skin Cancer

• UV radiation exposure (sun exposure, indoor tanning)
• Fair complexion
• History of sunburns or previous skin cancer
• Older age
• Male sex
• Family history (especially for melanoma)
• Multiple (≥100) nevi or atypical moles (for melanoma) 1

Treatment Selection Considerations

1. Tumor type (BCC, SCC, melanoma)
2. Tumor location (high-risk vs. low-risk areas)
3. Tumor size and depth
4. Patient factors (age, comorbidities, preferences)
5. Cosmetic considerations

Common Pitfalls to Avoid

• Underestimating SCC aggressiveness: While less common than BCC, SCC has greater metastatic potential
• Delayed treatment of melanoma: Early detection and treatment are critical for survival
• Inappropriate treatment selection: Superficial treatments for deeply invasive tumors can lead to recurrence
• Inadequate margins: Insufficient surgical margins increase recurrence risk
• Overlooking high-risk anatomic locations: Tumors in embryonic fusion planes, periocular, periauricular areas require more aggressive treatment

Surgical approaches remain the gold standard for most skin cancers, with specific techniques selected based on tumor characteristics, location, and patient factors. Non-surgical approaches are valuable alternatives for patients who cannot or prefer not to undergo surgery, or as adjunctive treatments in certain cases 1, 4.