Skin Cancer: An Update on Non-Melanoma and Melanoma with Travis Vandergriff, MD
SDPA Summer Conference Medical Director Travis Vandergriff, MD, reviewed the epidemiology of melanoma in a lecture focused on melanoma and non-melanoma in U.S. patients. Melanoma is the fifth most diagnosed cancer in people in the US with the highest incidence among non-Hispanic white males and the lowest incidence among black women. A review of data from 2009-2018 provided by the Centers for Disease Control and Prevention reveal the highest incidence of melanoma is in the western US. Patients who have a history of non-melanoma skin cancer (NMSC) have a four-fold increased risk of developing melanoma, therefore any patient with this history should be encouraged to have a full body skin examination. Furthermore, patients who have greater number of nevi as well as a history of dysplastic nevi are at an increased risk of developing melanoma in their lifetime. Dr. Vandergriff also discussed which patients should be screened for familial melanoma syndromes.
COVERAGE: SDPA Annual Summer Dermatology Conference, June 16-19, 2022, Austin, Texas
Next, Dr. Vandergriff discussed recent advancements in technology for the diagnosis of melanomas. Florescent in situ hybridization (FISH), which can be costly, is most often applied to spitz tumors and can take approximately a week to finalize. Mypath MelanomaTM is a company which provides a gene expression profile at one diagnostic data point to distinguish benign versus malignant melanocytic neoplasms. 2-GEP (DermTech TM) is a clinical decision tool which may help inform the decision to biopsy. This technology has a high sensitivity but lower specificity rate. Dr. Vandergriff further discussed the use of the latest edition of the American Joint Committee on Cancer (AJCC) for management of melanoma. Of note, patients with IIB or IIC melanomas should be referred for immunotherapy.
The continuum of actinic keratoses to squamous cell cancer was reviewed by Dr. Vandergriff. He highlighted a recent study out of Europe which reviewed the most common topical treatment options for actinic keratoses. This study revealed 5% 5FU as the most effective treatment for actinic keratoses followed by 5% imiquimod, with photodynamic therapy as the least effective for treatment of actinic keratoses of the three. Another study found the addition of calcipotriol (0.005% ointment) to 5% 5FU resulted in a significant reduction in AKs on the face at an eight-week follow-up. Chemoprevention of squamous cell cancers (SCC) in solid organ transplant patients should include acitretin with a goal of 25 mg daily. Unfortunately, the reduction of SCCs is limited to the duration of treatment. An additional supplement with low risk of side effects is nicotinamide, 500 mg p.o. bid, which can result in a modest reduction in both basal cell cancers (BCC) and SCCs. Finally, Dr. Vandergriff discussed the guidelines for use of immunotherapy and radiation therapy for SCCs.
Byline: Sarah B.W. Patton, PA-C
Pictured: Travis Vandergriff, MD, University of Texas Southwestern Medical Center