QUIZ RECAP: Treatment and Management of Skin Cancer

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This week we asked the question: How much do you know about the treatment and management of skin cancer?

Haven't taken our quiz yet? Pause before reading below and follow this link to complete it: here.

Below, we recap our fourth and final quiz and the correct answers to each question.

Question 1: What is the primary treatment modality for superficial basal cell carcinoma (BCC)?

Response options:

• Wide local excision
• Cryotherapy
• Mohs micrographic surgery
• Topical imiquimod

Correct response option: Topical imiquimod

Topical imiquimod is employed in treating specific abnormal skin conditions, including actinic keratosis, superficial basal cell carcinoma, and external genital warts. It is believed to modify the immune system’s response to aid in the removal of abnormal skin growths and is available under the brand names Aldara and Zyclara, as well as in generic forms.¹

Question 2: What is the recommended treatment for melanoma in situ (MIS) on the trunk or extremities?

Response options:

• Surgical excision with narrow margins
• Wide local excision with 1 cm margins
• Radiation therapy
• Topical chemotherapy

Correct response option: Wide local excision with 1 cm margins

International clinical guidelines typically suggest 5–10 mm margins for excising MIS. Despite limited evidence supporting this, the guidelines are fairly consistent. However, due to frequent subclinical extensions, especially in the lentigo maligna (LM) subtype, wider margins are often needed to ensure complete removal.²

Question 3: What is the role of adjuvant therapy in the management of high-risk melanoma?

Response options:

• Adjuvant immunotherapy or targeted therapy may be considered
• No role; surgery is the primary treatment
• Adjuvant chemotherapy is the standard of care
• Adjuvant radiation therapy is recommended for all cases

Correct response option: Adjuvant immunotherapy or targeted therapy may be considered

Adjuvant therapy given after surgery may reduce the risk of melanoma recurrence in patients with stage IIB-IV melanoma. Its purpose is to target and eliminate any remaining microscopic melanoma cells, potentially improving the overall chance of a cure by enhancing the immune system's ability to eradicate residual cancer cells, thereby delaying or preventing the return of melanoma and improving overall survival. Adjuvant therapy is especially considered for patients at high risk of recurrence after the primary treatment has removed all visible tumors.³

Question 4: Which medication is commonly used for the systemic treatment of advanced melanoma with BRAF V600 mutation?

Response options:

• Interferon-alpha
• Dacarbazine
• Ipilimumab
• Vemurafenib

Correct response option: Vemurafenib

The FDA has approved several medications for advanced melanoma with a BRAF V600 mutation, including:⁴

• Dabrafenib: Approved in 2013, this drug is an ATP-competitive inhibitor targeting RAF kinases to block the activity of V600-mutated BRAF proteins. In 2022, it received accelerated approval for use in combination with trametinib to treat unresectable or metastatic solid tumors with the BRAF V600E mutation.
• Vemurafenib: Another RAF inhibitor approved by the FDA, vemurafenib has demonstrated improved progression-free survival (PFS) compared to dacarbazine in trials. However, melanomas with the BRAF V600E mutation can quickly develop resistance to single-agent RAF inhibitors.

Question 5: True or False: Topical photodynamic therapy (PDT) is an effective treatment option for nodular basal cell carcinoma.

Response options:

• True
• False
• Partially true
• True only for superficial BCC

Correct response option: True

PDT is a noninvasive treatment for small nodular BCCs. It involves applying a photosensitizing agent, such as aminolevulinic acid or methyl aminolevulinate, to the skin. When exposed to visible light, this agent produces reactive oxygen species that destroy cancer cells. PDT also damages the cancer's blood vessels, cutting off its nutrient supply, and may stimulate the immune system to attack the tumor cells.⁵

References

1. WebMD. Imiquimod topical - uses, side effects, and more. WebMD website. https://www.webmd.com/drugs/2/drug-1191-8193/imiquimod-topical/imiquimod-topical/details. Accessed May 30, 2024.
2. Friedman EB, Scolyer RA, Williams GJ, Thompson JF. Melanoma In situ: A critical review and re-evaluation of current excision margin recommendations. Adv Ther. 2021;38(7):3506-3530. doi:10.1007/s12325-021-01783-x
3. Eljilany I, Castellano E, Tarhini AA. Adjuvant therapy for high-risk melanoma: An in-depth examination of the state of the field. Cancers (Basel). 2023;15(16):4125. August 16, 2023. doi:10.3390/cancers15164125
4. Johnson DB, Puzanov I. Therapy for BRAF-mutant metastatic melanoma: Approaches for improved clinical outcomes. Am Soc Clin Oncol Educ Book. 2020;(40):1-13. doi:10.1200/EDBK_174934.
5. Rhodes LE, de Rie M, Enström Y, et al. Photodynamic therapy using topical methyl aminolevulinate vs surgery for nodular basal cell carcinoma: Results of a multicenter randomized prospective trial. Arch Dermatol. 2004;140(1):17–23. doi:10.1001/archderm.140.1.17