Detecting Skin Cancer - Tips to Prevent & Treat by Dr. Cameron Rokhsar

Video Name: Detecting Skin Cancer - Tips to Prevent & Treat by Dr. Cameron Rokhsar
Video Tags: sclerosing basal cell carcinoma, infiltrative basal cell carcinoma, basal cell carcinoma scalp, basal carcinoma
Description: Dr. Cameron Rokhsar, New York based skin cancer surgeon, discusses the prevention, detection and treatment of various forms of skin cancer including melanoma, basal cell carcinoma, squameous cell carcinoma and actinic keratosis on ABC's Good Morning America. Skin cancer is the most common form of cancer.

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The management of basal cell carcinoma
Photodynamic therapy
Mainly due to its good cosmetic outcome the use of topical photodynamic therapy (PDT) in the management of BCC becomes more and more available in dermatological centres. In a study of 151 BCCs treated with PDT without long-term follow-up, 88% demonstrated a complete response. 74 (Strength of Evidence C, II-iii) Long-term follow-up data on large series is needed to demonstrate whether or not topical PDT has a role in the management of BCC. Methyl aminolevulinate PDT was recently shown to be an effective treatment even for nodular BCC. 75 However, as depth of penetration of the photosensitizer appears to be a limiting factor with topical PDT, without previous curettage PDT it is only likely to be of benefit for the treatment of superficial BCC in low risk areas. 75-76 (Strength of Evidence C, III) A report from the British Photodermatology Group suggests topical ALA-PDT to be an effective therapy for superficial (<2 mm thick) BCC.

Chemotherapy

Chemotherapy has been used both for the management of uncontrolled local disease and for patients with metastatic BCC, which is both an extremely rare and a rapidly fatal condition. A cisplatin (CDDP)- based chemotherapy (including doxorubicin) as sole therapy and as neoadjuvant (NA) therapy revealed a complete remission in eight of 28 patients (28%) suffering from advanced basal cell and squamous cell cancers, a partial remission was achieved in 11 of 28 patients (40%)

Palliation and observation

In some instances the patient’s general health or condition may indicate palliation and / or observation. The risk /benefit ratio must be considered individually to assess whether the cases warrants only palliation, observation or both. In the debilitated patient aggressive treatment may be inappropriate. Observation alone or simple debulking or RT may achieve local control and improve quality of life.

Retinoids
Oral retinoid therapy may prevent or delay the development of new BCCs. Such therapy has mainly been used in patients with the basal cell nevus (Gorlin's) syndrome and may also have a lesser effect in producing partial regression of existing BCCs. A recent study questioned the benefit of acetretin in preventing BCCs. 81 Unfortunately, the relatively high doses necessary mean that compliance may be poor, and relapse occurs following the discontinuation of treatment.

Follow-up

Long-term hospital-based follow-up of all patients after treatment of BCC is neither necessary nor recommended. However, follow-up can be important for selected patients, although there is no clear consensus on either the frequency or total duration or such review. The main arguments for follow up are: (i) early detection of tumour recurrence; (ii) early detection and treatment of new lesions; and (iii) patient education, especially regarding sun protection measures. Most evidence suggests that the majority of BCCs that recur, will present within 5 years of treatment, although up to 18% will recur after this.A review of all studies published since 1947 suggested that for primary (previously untreated) BCCs treated by a variety of modalities less than one-third of all recurrences occurred in the first year following treatment, 50% appear within 2 years, and 66% within 3 years. 41 Patients who have had one BCC are at significantly higher risk of developing new primary lesions,many of which may go unnoticed by patients. In a 5-year prospective follow-up study of 1000 patients following treatment for BCC, 36% developed new primary BCCs and 20% of patients with very fair skin types and frequent sun exposure went on to develop multiple BCCs. 15 Consequently, some authors have recommended long-term, even lifetime follow-up, particularly for patients with high-risk or multiple lesions. 41,83 In contrast to this special group patients with single BCCs completely excised in low risk sites possibly do not require follow up.

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