Understanding Two Types Of Advanced Non-melanoma Skin Cancer
It's the summer. Time for hot dogs and hiking, barbecues and beach vacations. In much of the U.S., we're slowly preparing to return to a life post-pandemic and enjoying the summer sun is in many peoples' plans. Part of this return to outdoor life also means a return to familiar summer health concerns – things like wearing sunblock outside and covering up with a hat, remembering to use an umbrella at the beach, and checking your skin for spots.
The safety and logistical challenges of the COVID-19 pandemic have led to people across the country delaying important screenings and medical care.1 This is also true for two common forms of non-melanoma skin cancer (NMSC), basal cell carcinoma (BCC) and cutaneous squamous cell carcinoma (CSCC), where there was a decline in diagnoses in 2020 compared to 2019.2 It is possible that the delay in early diagnosis and intervention may lead to patients initially presenting with more advanced CSCC and locally advanced BCC with a worse prognosis. Understanding the signs of progressing skin cancer and being proactive is especially important for people with a history of or at a high risk for BCC or CSCC.
Understanding Advanced BCC and Advanced CSCC
While most people are familiar with melanoma, fewer know about BCC and CSCC. These two are among the most common cancers in the world and occur most frequently due to prolonged overexposure to the sun and mainly occur in people over the age of 65.3,4,5
BCC is the most common skin cancer globally, and CSCC is not far behind.3 The vast majority are usually treated at an early stage and can be cured, but a small percentage may become advanced, meaning they penetrate deep into the skin and the surrounding tissue or spread to other parts of the body.6 At this point, these two cancers can be like any other cancer that has advanced – much more serious and potentially even life-threatening.7
There are a variety of different and effective treatments for addressing early-stage BCC and CSCC, and most people are treated easily, right in their dermatologist's or surgeon's office. Treatments may include electrosurgery, Mohs surgery, excisional surgery, radiation, photodynamic therapy, cryosurgery, laser surgery and topical medications.8,9
There is no way to be certain who is more likely to develop advanced BCC or advanced CSCC, but sometimes characteristics of early disease may be indicators of a greater chance of it becoming more serious later. The location of the cancer and how fast it grows, for instance, might make it more likely that it will advance.10 But the best way to take care of yourself is to be proactive, which starts by understanding these two types of advanced NMSC and making your skin health a priority. You can learn more about advanced BCC and advanced CSCC, including a potential treatment option, at UnderstandAdvancedCSCC.com.
Frequent Visits and Informed Discussions With a Dermatologist
Dr. Larisa Geskin, Associate Professor of Dermatology and Director of the Comprehensive Skin Cancer Center at Columbia University, says one of the best ways for people to manage their skin health and be their own best advocates for their advanced BCC or advanced CSCC treatment is to proactively schedule appointments with their dermatologist.
"I can't emphasize this enough. People need to be vigilant about regular visits to their doctor, especially if you have a history of BCC or CSCC, a new or unusual spot on your skin or if your skin cancer is recurring despite ongoing treatment. If your cancer keeps coming back even after surgeries or other therapy, it is important to talk openly with your doctor about your options."
New and Evolving Treatment
For a long time, there weren't many options for advanced BCC or advanced CSCC. For many people, if surgery, chemotherapy and radiation didn't work, alternative treatment options were severely limited. All doctors could do was to attempt to keep painful symptoms under control.6
Today, however, new advancements are changing this outlook. For some people, systemic treatments may be an option for those with advanced BCC or advanced CSCC who are not showing improvement despite ongoing treatment or who aren't eligible for surgery or radiation.
For people who are diagnosed with advanced BCC or advanced CSCC, you'll probably need to see a multidisciplinary team of doctors to put together a treatment plan.10 Your dermatologist will work with an oncologist and others to determine options, but having regular conversations with your dermatologist even before this is the best way to help identify what might work for you.
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References
1. Czeisler MÉ, et al. Delay or Avoidance of Medical Care Because of COVID-19–Related Concerns — United States, June 2020. MMWR Morb Mortal Wkly Rep 2020;69:1250–1257. DOI: https://www.cdc.gov/mmwr/volumes/69/wr/mm6936a4.htm
2. Marson JW, et al. The Magnitude Of COVID-19's Effect On The Timely Management Of Melanoma And Non-Melanoma Skin Cancers. J Am Acad Dermatol 2021; 84(4): 1100-1103.
3. Ciążyńska, M., Kamińska-Winciorek, G., Lange, D. et al. The incidence and clinical analysis of non-melanoma skin cancer. Sci Rep 11, 4337 (2021). https://doi.org/10.1038/s41598-021-83502-8
4. CSCC Misperceptions Survey. Conducted by Harris Poll for The Skin Cancer Foundation, May 2019.
5. Garcovich, et al. Aging and Disease. 2017 Oct;8(5):643–661
6. Migden, M. et al. Emerging trends in the treatment of advanced basal cell carcinoma. Cancer Treatment Reviews 2017; 64(2018): 1-10
7. Califano JA, Lydiatt WM, Nehal KS, et al. Cutaneous squamous cell carcinoma of the head and neck. In: Amin MB, Edge SB, Greene FL, et al, eds. AJCC Cancer Staging Manual. 8th ed. Springer; 2017:171-181
8. Basal Cell Carcinoma Treatment. https://www.skincancer.org/skin-cancer-information/basal-cell-carcinoma/bcc-treatment-options/. Accessed April 23, 2021.
9. Squamous Cell Carcinoma Treatment. https://www.skincancer.org/skin-cancer-information/squamous-cell-carcinoma/scc-treatment-options/. Accessed April 23, 2021.
10. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines®) for Squamous Cell Skin Cancer V.1.2021. National Comprehensive Cancer Network, Inc. 2021.