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  • Presentation

Recent Advances in Skin Cancer Prevention, Diagnosis, Staging, and Treatment

Description

The talk reviewed recent advances across the skin cancer spectrum, emphasizing prevention, diagnosis, staging, prognosis, and treatment. On prevention, it highlighted the Safe Sunscreen Standards Act and a promising new sunscreen filter with broad UV protection, as well as evidence that nicotinamide lowers skin cancer risk, especially when started earlier. For non-melanoma skin cancers, the speaker stressed that squamous cell carcinoma in situ can harbor invasion and that staging is evolving beyond AJCC and BWH systems toward genomic testing such as 40-GEP, which helps identify high-risk patients, guide radiation decisions, and refine management. Advanced squamous cell carcinoma treatment has improved with immunotherapy, including cemiplimab and a newer potentially less toxic agent. Basal cell carcinoma management remains active, with data supporting curettage-based approaches in some cases, hedgehog inhibitors for advanced disease, and immunotherapy after hedgehog failure. Merkel cell carcinoma treatment also benefits from PD-1 therapy, with viral antibody titers emerging as a useful tool for surveillance. In melanoma, incidence and mortality remain high, but dermatologist density appears associated with lower mortality, suggesting dermatology access matters. The speaker emphasized AI as an important adjunct in diagnosis rather than a replacement for dermatologists. Prognosis is increasingly shaped by genomic profiling, which can outperform thickness alone, identify patients needing sentinel node biopsy or adjuvant radiation, and improve risk stratification. Finally, neoadjuvant and combination immunotherapy are improving long-term outcomes in advanced melanoma, making metastatic disease no longer an automatic death sentence, though not yet a definitive cure.

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Conclusions

  • Skin cancer incidence and mortality remain high and are still rising overall, making prevention, early detection, and improved treatment increasingly important.
  • A modernized sunscreen approval process and the introduction of new, photostable broad-spectrum UV filters may strengthen prevention efforts.
  • Nicotinamide appears to reduce future skin cancer risk, especially when started earlier in patients with prior skin cancers.
  • Squamous cell carcinoma should be taken seriously because in situ lesions can harbor invasive disease, and staging is becoming more precise with genomic risk profiling.
  • Gene expression profiling can better identify high-risk squamous cell carcinoma patients, help guide radiation decisions, and improve selection of patients for more intensive management.
  • For advanced cutaneous squamous cell carcinoma, immune checkpoint therapy improves survival and newer agents may offer effective options with acceptable toxicity.
  • Basal cell carcinoma remains common, and some patients may be managed effectively with curettage-based approaches or alternative therapies, while hedgehog inhibitors and immunotherapy are useful for advanced disease.
  • In basal cell carcinoma, sonidegib appears to be better tolerated than vismodegib, leading to longer treatment persistence and fewer adverse effects.
  • Merkel cell carcinoma outcomes have improved with PD-1 therapy, and rising or falling polyomavirus antibody titers may help tailor surveillance intensity.
  • Melanoma incidence is increasing in the U.S. and globally, but mortality has improved with modern systemic therapies and remains an area where dermatologists can make a measurable difference.
  • Higher dermatologist density is associated with lower melanoma mortality, suggesting access to dermatologic expertise improves outcomes.
  • Clinical melanoma diagnosis still has limitations, but AI can augment dermatologist performance and is best used as a decision-support tool rather than a replacement.
  • Traditional prognostic factors like Breslow thickness remain important, but genomic testing adds meaningful independent prognostic information and may improve risk stratification.
  • Genomic tests can identify truly low-risk and truly high-risk melanoma patients, helping refine decisions about sentinel lymph node biopsy and follow-up intensity.
  • Patients with node-negative melanoma still include a substantial high-risk subset, so negative sentinel node status alone should not be considered fully reassuring.
  • Neoadjuvant and combination immunotherapy approaches are improving outcomes in advanced melanoma, and long-term survival for some patients is now approaching durable remission.
  • Overall, the field is moving toward more personalized skin cancer care through better prevention, genomics, AI-assisted diagnosis, and more effective systemic therapies.
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