Beyond the Knife: Practical Nonsurgical Options for Skin Cancer

In Episode 64 of Derms and Conditions, our host, Dr James Q. Del Rosso sits down with Dr Shane Chapman, Chair of the Department of Dermatology at Dartmouth Hitchcock Medical Center, to discuss nonsurgical approaches to treating nonmelanoma skin cancer.  Dr. Chapman begins by discussing topical treatment options for nonmelanoma skin cancer for patients who are not candidates for surgery. He comments on the use of intralesional chemotherapy for keratoacanthomas or squamous cell carcinomas in poorly healing areas or when multiple lesions are present, compares the benefits of 5-fluorouracil and intralesional methotrexate, and explains the benefits of using oral acitretin with intralesional therapy. The pair then discuss intralesional methotrexate in more detail, explaining how methotrexate and 5-fluorouracil can be interchanged or used in combination with PDT to treat keratoacanthomas/squamous cell carcinomas. They also discuss how to approach a case of a patient with a nodular basal cell carcinoma on her nasal tip who refuses treatment with surgery or radiation. Next, they discuss treatment of broader skin lesions, such as superficial or multifocal basal cell carcinomas and detail imiquimod, 5-fluorouracil, and both red and blue light PDT as potential treatment options. To conclude, they discuss how to manage brisk imiquimod responses and the impact on treatment duration. Tune into this episode to hear the full details and learn more!