New Directions in the Treatment of Basal Cell Carcinoma - Episode 5

Future of BCC

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Expert dermatologists discuss future directions for the management of basal cell carcinoma.

Sherrif F. Ibrahim, MD, PhD: Maybe you can sum up in a few sentences where the field has been in the last few years and where it’s going, and then we can finish by talking about one of the cases that I’ve seen in my practice before we wrap it up.

Vishal Patel, MD, FAAD, FACMS: It’s exciting that we’re seeing the change of focus to harnessing our immune system, at least for the advanced and metastatic cases. We know from what happens to patients who have suppression of the immune system or organ transplants how much skin cancer can wreak havoc on their lives. Now we have 2 options for those patients when surgery can be debilitating or they aren’t able to tolerate surgery.

[We can use] hedgehog inhibitors, the tolerability of which still remains an issue. The main 3 adverse effects—hair loss, muscle pains or taste loss—appear in most patients around the 3-month mark, and there are ways to mitigate that with alternate dosing strategies that may help the patient tolerate that. But when they don’t, immune checkpoint inhibitors are game changers. They are the holy grail to oncology. We’re seeing that across cancer types. We saw that in squamous cell carcinoma at a much higher rate than in basal cell carcinoma. We can discuss why that is. But now we have an option for patients who had nothing. Chemotherapy and radiation aren’t great for this nonresponsive tumor type. We’re excited to see what will come down the pipeline with dual combinations. Checkpoint inhibitor therapy is going to be investigated next, and even potentially intralesional chemotherapy into those tumors instead of systemic infusion.

Sherrif F. Ibrahim, MD, PhD: It’s exciting to see so many things coming down the pike that work and that will put control in the hands of the dermatologists. The best is yet to come. It’ll be interesting to have this.

Vishal Patel, MD, FAAD, FACMS: Intralesional is going to be interesting if it comes to fruition. It’s being investigated now. We’re the experts with procedural treatment of skin cancer, so it’s important to get to know this because it may be down the pipeline in the near future.

Sherrif F. Ibrahim, MD, PhD: One hundred percent.

Transcript edited for clarity