Management of Melanoma and Advanced Non-Melanoma Skin Cancers of the Face

Jeffrey S. Moyer, MD

In 2020, the treatment of skin cancer remains primarily surgical with the goal of treatment being pathologically clear margins and the functional and aesthetic reconstruction of the resulting defects. Some of the most exciting advances have come from both targeted and immunotherapeutic strategies to address advanced disease, both in the adjuvant as well as neoadjuvant setting. There is growing optimism that some previously unresectable tumors may become resectable with these treatments, and in some instances, complete responses may obviate the need for surgical resection. In fact, melanoma mortality has declined by 7% annually since 2013 following the Food and Drug Administration (FDA) approval of the first checkpoint inhibitor ipilimumab and BRAF inhibitor vermurafenib in 2011.[1] This is a striking turn-around for a disease where few treatments have meaningfully impacted survival despite expansive research efforts. While cutaneous squamous cell carcinoma and basal cell carcinoma statistics are unfortunately not tracked by cancer registries, there have been promising results in several studies with the same immunotherapeutic agents in advanced cutaneous carcinomas. We hope to see similar mortality improvements in this difficult-to-treat population as therapeutic regimens become more refined. Despite the excitement and well-deserved press with immunotherapy, we must not lose sight of the fact that the mainstay of skin cancer management is the early diagnosis and appropriate surgical management of this disease. We must continue to focus on our surgical outcomes to embrace techniques with the lowest chance of recurrence and the best postoperative results with an eye toward quality and cost-effectiveness.

• Reference

• 1 Siegel RL, Miller KD, Jemal A. Cancer statistics, 2020. CA Cancer J Clin 2020; 70 (01) 7-30