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- Presentation
Updates in Skin Cancer Management and Cosmetic Dermatology: Surgical, Preventive, and Aesthetic Treatments
Description
Dr. Alam reviewed practical updates in skin cancer management and cosmetic dermatology, emphasizing that much of the evidence comes from retrospective or small studies and should be interpreted cautiously. In skin cancer, he noted promising data for adjuvant simiplumab in high-risk cutaneous squamous cell carcinoma, modest chemoprevention from nicotinamide, and possible reductions in recurrence with adjuvant radiation, pulse dye laser treatment, and incidental PD-1/PD-L1 inhibitor exposure. Mohs surgery appeared to improve local control for Merkel cell carcinoma, and postoperative defect size was described as a reasonable proxy for clinical size in staging cutaneous squamous cell carcinoma. He also highlighted high concordance between Mohs surgeons and dermatopathologists when immunohistochemistry is used for melanoma in situ, and suggested prophylactic antibiotics may not meaningfully reduce already-low Mohs infection rates. Early takedown of interpolation flaps may improve quality of life without increasing failure. In cosmetic dermatology, he discussed a promising 1726-nm laser for acne, combined CO2 laser and triamcinolone for keloids, high-intensity ultrasound for crepiness, botulinum toxin for platysmal bands, and no clear short-term mandibular bone harm from repeated masseter toxin injections. He concluded that exosomes lack strong evidence, PRP has supportive randomized data for androgenetic alopecia mainly improving hair density, botulinum toxin A may not help extra-facial scars, and shorter-acting toxin E can be useful when temporary brow effects are desired.
View moreConclusions
- Adjuvant cemiplimab appears to improve disease-free survival in high-risk cutaneous squamous cell carcinoma, although longer follow-up is still needed.
- Nicotinamide seems to provide a modest chemopreventive benefit for keratinocyte carcinomas, especially when started after the first skin cancer.
- Adjuvant radiation after high-risk cutaneous squamous cell carcinoma surgery may reduce local and nodal recurrence, but retrospective bias limits certainty about survival benefit.
- Pulsed dye laser treatment may lower the risk of later keratinocyte carcinoma on the face, though the evidence remains retrospective and potentially confounded.
- PD-1/PD-L1 inhibitor exposure may have an incidental chemopreventive effect against non-melanoma skin cancers.
- Mohs surgery for Merkel cell carcinoma appears to improve local control, even if it may not change the systemic course of disease.
- Postoperative defect size after Mohs can serve as a reasonable proxy for staging high-risk cutaneous squamous cell carcinoma when preoperative size is unavailable.
- Mohs surgeons and dermatopathologists show high concordance in interpreting melanoma in situ margins when immunohistochemistry is used.
- Routine prophylactic antibiotics for lower-extremity Mohs surgery do not appear to reduce infection rates enough to justify broad use.
- Early takedown of interpolation flaps, around two weeks, seems to be safe and can reduce the burden of prolonged reconstruction.
- The 1726-nm sebum-selective laser appears to be a promising nonpharmacologic treatment for acne with durable improvement.
- Combining carbon dioxide laser with triamcinolone appears more effective for keloids and hypertrophic scars than monotherapy, though the evidence is heterogeneous.
- High-intensity ultrasound may help improve facial skin crepiness and laxity with good patient satisfaction and minimal side effects.
- Botulinum toxin is effective for improving platysmal bands.
- Repeated onabotulinumtoxinA injections for masseter prominence do not appear to harm mandibular bone density over about one year.
- Exosome-based aesthetic treatments remain popular, but current evidence for clinical benefit is weak.
- Platelet-rich plasma improves hair density in androgenetic alopecia, but the gain in hair diameter is less clear.
- Botulinum toxin A does not significantly improve the aesthetic appearance of extrafacial scars, though it may reduce itching.
- Adjuvant Cemiplimab for High Risk Cutaneous Squamous Cell Carcinoma.#10.3390/curroncol32080459
- Nicotinamide for Skin Cancer Chemoprevention.#10.1001/jamadermatol.2025.3237
- Adjuvant Radiation is Associated with Reduced Risks of Local Recurrence and Nodal Metastasis in High-Risk Localized Cutaneous Squamous Cell Carcinoma.#10.1016/j.ijrobp.2025.10.007
- Pulsed Dye Laser Treatment is Associated with Decreased Development of Subsequent Keratinocyte Carcinoma.#10.1097/dss.0000000000004777
- Chemoprophylactic Effect of PD-1/PD-L1 Inhibitor Treatment on Non-Melanoma Skin Cancer Development.#10.1016/j.jaad.2025.11.057
- Mohs Surgery of Merkel Cell Carcinoma Lowers Local Recurrence Risk.#10.1007/978-1-4471-2152-7_24
- Postoperative Defect Size Correlates with Histological Extent for Staging High-Risk Cutaneous Squamous Cell Carcinoma Treated with Mohs.
- Concordance Between a Mohs Surgeon and Dermatopathologist on Margin Status for Melanoma In Situ.
- Retrospective Review of the Infection Rate of Lower Extremities Treated with Mohs Micrographic Surgery With and Without Prophylactic Antibiotics.#10.1097/dss.0000000000004652
- Outcome of Early Takedown of Interpolation Flaps.
- 1726-nm Sebum-Selective Laser for Acne Treatment.
- Combination of Carbon Dioxide Laser and Triamcinolone Acetonide for Keloids and Hypertrophic Scars.
- High-Intensity Ultrasound Treatment for Skin Crepiness/Laxity.
- Improvement of Platysmal Bands with Botulinum Toxin.#10.1007/978-1-4419-1093-6_1
- No Negative Impact of OnabotulinumtoxinA for Masseter Prominence on Mandibular Bone Density.
- The Evidence for Exosomes in Aesthetic Medicine.
- Platelet-Rich Plasma in the Treatment of Androgenetic Alopecia.
- Botulinum Toxin Type A: Is it Really Useful in Improving the Aesthetic Results of Extrafacial Scars?