Systemic treatment of advanced cutaneous squamous and basal cell carcinomas
- Renato G Martins, MD, MPH
Renato G Martins, MD, MPH
- Medical Director
- University of Washington
- Seattle Cancer Care Alliance
- Section Editors
- Robert S Stern, MD
Robert S Stern, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Dermatology
- Harvard Medical School
- June K Robinson, MD
June K Robinson, MD
- Section Editor — Nonmelanoma Skin Cancer
- Professor of Clinical Dermatology
- Northwestern University Feinberg School of Medicine
Basal cell carcinoma and squamous cell carcinoma of the skin, together referred to as nonmelanoma skin cancer (NMSC), are the most commonly diagnosed malignant neoplasms in the Caucasian population of the United States. Because many patients are treated as outpatients in an office setting, reliable statistics are difficult to obtain. Nonetheless, the National Cancer Institute estimates that approximately two million new cases occurred in 2012 .
The vast majority of patients can be successfully managed with a variety of simple procedures, such as cryotherapy, curettage and electrodesiccation, topical treatments (fluorouracil, imiquimod), or simple surgical excision. When lesions are more advanced, Mohs micrographic surgery, more extensive surgical resection, or radiation therapy are generally sufficient to control locoregional disease.
Despite their high prevalence, these NMSCs are rarely fatal. It is estimated that in 2012 , approximately 1000 patients died of the disease. Squamous cell carcinomas are biologically more aggressive, and neglected lesions can be life-threatening due to local extension or metastasis. By contrast, basal cell carcinoma is only very rarely life-threatening.
The use of systemic therapy is limited to patients with distant metastases or locally advanced disease that cannot be adequately managed with surgical or radiotherapeutic techniques.
Systemic chemotherapy for basal cell and squamous cancers of the skin is discussed here. The treatment of localized basal cell and squamous cell carcinomas is discussed elsewhere. (See "Treatment and prognosis of basal cell carcinoma at low risk of recurrence" and "Treatment of basal cell carcinomas at high risk for recurrence" and "Treatment and prognosis of cutaneous squamous cell carcinoma".)
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- TNM STAGING SYSTEM
- BASAL CELL CARCINOMA
- Targeted therapy: Hedgehog pathway
- - Vismodegib
- - Sonidegib
- - Itraconazole
- SQUAMOUS CELL CARCINOMA
- Treatment targeting the EGFR pathway
- Systemic chemotherapy
- Chemotherapy plus cetuximab
- Checkpoint inhibitor immunotherapy
- ALLOGENIC ORGAN TRANSPLANTATION
- SUMMARY AND RECOMMENDATIONS