Nonmelanoma Skin Cancer Beyond Surgery: PDT, Immunotherapy, and Pipeline Agents

Todd Schlesinger, MD, a dermatologist and trialist in Charleston, South Carolina, reviewed recent developments in nonmelanoma skin cancer during an interview at Fall Clinical 2026. He holds a faculty appointment at George Washington University School of Medicine and Health Sciences and directs the Clinical Research Center of the Carolinas. In his sessions, Schlesinger highlighted a new topical plus photodynamic therapy (PDT) indication for basal cell carcinoma, adjuvant immunotherapy for nonmelanoma skin cancers, and sequential approaches for actinic keratoses.

Ameluz and PDT for Superficial Basal Cell Carcinoma

Schlesinger first highlighted the approval of Ameluz (aminolevulinic acid hydrochloride) topical gel 10% plus photodynamic therapy for superficial basal cell carcinoma as the top development. The approval followed a study published in JAAD in January, for which he served as lead author. He noted the label permits treatment pretty much anywhere on the body.

“So now we can use photodynamic therapy with red light, 3-hour incubation, and 2 to 4 cycles to treat superficial basal cell carcinoma,” Schlesinger said.

Immunotherapy Options in Cutaneous Squamous Cell Carcinoma

Adjuvant cemiplimab (Libtayo; Regeneron) is an option after surgery and radiation for patients with locally advanced squamous cell carcinoma and high-risk features. Schlesinger cited perineural invasion, multiple lymph nodes, and deep tumor invasion as examples. He called the adjuvant approach a new adoption in skin cancer.

Cosibelimab (Unloxcyt; Sun Pharma), a PD-L1 inhibitor, is also approved for locally advanced and metastatic cutaneous squamous cell carcinoma. It is given intravenously, as is cemiplimab, and pembrolizumab (Keytruda; Merck) remains approved.

Sequential Therapy for Actinic Keratoses

Sequential photodynamic therapy, sequential tirbanibulin, and other topicals can be used to treat actinic keratoses. Schlesinger described the condition as chronic, requiring ongoing management. The tirbanibulin label reflects a single course from the studies, though many clinicians repeat it twice a year.

“It’s important to be able to set your patients up for twice a year photodynamic therapy,” Schlesinger said.

Some clinicians also continue to rely on older standard topicals such as imiquimod and 5-fluorouracil (5-FU), Schlesinger noted.

Nonsurgical Options in Development

Beyond surgery, Schlesinger pointed to pulsed energy devices as a possible option for basal cell carcinoma. Intralesional therapies include an oncolytic peptide and a shuttle peptide, and new mechanisms of action are in development. An intralesional cemiplimab study is underway at his site and others.

“I think the innovation is very high in the pipeline for skin cancer,” Schlesinger said.

He expects more companies to enter with nonsurgical options for basal cell carcinoma, squamous cell carcinoma, melanoma, Merkel cell carcinoma, and others.