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Mohs surgery, topical chemotherapy are gold standards


Mohs surgery and topical chemotherapy are among the most effective treatments for certain types of skin cancer, according to David J. Goldberg, M.D. In the very near future, however, photodynamic therapy - now commonly used with good results in Europe - may well become the gold-standard treatment for skin cancers in the United States.

Key Points

New York - Doctors have made significant progress in treating both melanoma and nonmelanoma skin cancers, as well as precancerous conditions. And, as is the case with dermatology in general, many of these treatments are being used in combination.

According to statistics from the National Cancer Institute, there were an estimated 1 million new cases of nonmelanoma skin cancer in the United States in 2007, with fewer than 2,000 deaths resulting.

The American Academy of Dermatology estimates that more than 46,000 Americans are diagnosed with melanoma skin cancer annually, and that nearly 8,000 will die from it.

"These include freezing, electrodesiccation and curettage, standard surgery and Mohs skin-cancer surgery," Dr. Goldberg tells Dermatology Times.

"For either recurrent skin cancers or skin cancers in some difficult areas such as the nose, eyelid, lips and around the ear, Mohs surgery will both remove the least amount of normal skin and provide the highest cure rate," he says.

Dr. Goldberg says freezing is also an effective therapy for precancerous skin conditions.

"Liquid nitrogen is the most commonly used in-office technique for the treatment of precancers, or actinic keratoses," he says.

"This therapy has the benefits of simplicity, quickness, a high success rate and minimal in-office expense. Its disadvantages relate to the discomfort of treatment and the resultant cosmetically unacceptable white spots that are commonly seen after treatment."

According to Dr. Goldberg, topical chemotherapy is also effective in the treatment of certain precancerous conditions.

"Several topical chemotherapeutic agents are used for precancerous actinic keratoses," he says. "Among the most commonly used topical agents today are topical 5-fluorouracil and topical imiquimod."

Dr. Goldberg says the advantages of topical chemotherapeutic agents include ease of use by the patient between treatments and significantly high success rates.

"The disadvantages include the need for several weeks of use during the treatment period, the awful look that the skin acquires during treatment - the so-called 'pizza face' look - and the fact that not all insurance companies cover, for example, topical imiquimod use," he says.

When it comes to skin cancer therapies that are most in vogue currently - and the reasons for them having attained that status - Dr. Goldberg says that, in his opinion, Mohs surgery has become the up-trending treatment.

"Mohs surgery has become very popular, because it has the highest cure rate, and potentially, because of its tissue-sparing quality, leads to the best cosmetic result," he says.

And though substantial progress has been made in treating skin cancer, as well as precancerous conditions, much research is being carried out to discover new therapies that may have the potential to be even more effective than those in vogue in the United States today.

"If I were to do some 'crystal-balling' about skin cancer therapies that are in the pipeline that could become gold standard in the fairly near future domestically, I'd point to photodynamic therapy," Dr. Goldberg says.

"PDT has become a very popular therapy for the treatment of actinic keratoses, for instance. This one-time in-office procedure has the advantages of simplicity of treatment, minimal discomfort, success rates as high as any other technique and - perhaps most importantly - it has cosmetically elegant results.

"Photodynamic therapy, which is very popular for the treatment of skin cancers in Europe, will, in all likelihood, find its way into the common everyday dermatology practice in the United States," Dr. Goldberg says.

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