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Presentation

Prevention and Active Surveillance for Keratinocyte Carcinoma

Description

The presentation discusses prevention and active surveillance strategies for keratinocyte carcinoma, particularly focusing on evidence-based therapies and the risks/benefits of active monitoring. The speaker highlights a case study of a 71-year-old man seeking to prevent further surgeries after a squamous cell carcinoma diagnosis, advocating for topical treatments like 5-fluorouracil and combination therapies with calcipotriol, which show significant relative risk reductions in recurrence. New data on laser treatments reveals promising results with reduced future KC occurrences. Additionally, the use of nicotinamide as an oral chemopreventive agent is explored, showing a 23% reduction in subsequent keratinocyte carcinomas, with reassuring data regarding cardiovascular risks. Active surveillance is discussed, particularly for low-risk basal cell carcinoma patients, emphasizing the importance of patient selection and monitoring them without immediate intervention. The approach focuses on reducing unnecessary treatments for non-aggressive tumors, especially in older patients or those with multiple comorbidities, while ensuring patient comfort and matching treatment to individual care goals. The presentation concludes with a summary of key takeaways, including findings on field prevention, the benefits of laser therapies, and the role of nicotinamide, affirming the viability of active surveillance for appropriate cases.

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Conclusions

Topical 5-Fluorouracil (5-FU) significantly reduces the risk of squamous cell carcinoma in high-risk patients but the effects diminish over time.
Combination therapy of 5-FU and calcipotriol shows prolonged efficacy and is generally preferred by patients for its shorter treatment duration.
Fractionated laser resurfacing may reduce the risk of future keratinocyte carcinomas significantly based on recent studies, although cost and insurance coverage are barriers to its use.
Oral nicotinamide offers a significant reduction in the risk of new keratinocyte carcinomas among those with a prior history, without increased cardiovascular risk.
Active surveillance is a viable option for low-risk basal cell carcinoma in patients with limited life expectancy or those who cannot undergo surgery, especially for asymptomatic cases.
Regular monitoring of low-risk basal cell carcinomas is crucial, with reassessment at intervals to ensure no excessive growth or symptoms arise.
In cases where a biopsy reveals a positive margin but no clinical residue after monitoring, it may be reasonable to continue watching rather than treating immediately.
Shave saucerization can effectively remove small lesions while also providing a pathological diagnosis, especially for superficial non-melanoma skin cancers.

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