Genetic profiling is valuable in both diagnosis and prognosis of skin cancer. Hedgehog inhibitors and (superficial radiation therapy) SRT are strong contenders for treating nonmelanoma skin cancer. Advances in targeted therapies and biologics are part of the new wave of melanoma treatments.
All surgical management of melanoma is defined by Breslow thickness. For melanoma less than 1 mm in thickness, typically a SLNB is not required. Future imaging devices may better delineate the extent and depth of the tumor in vivo.
Cyclosporine and PUVA clearly increase the risk of squamous cell carcinomas, and there is evidence that TNF blockers and methotrexate may do so to a lesser degree. UVB phototherapy has not been shown to cause skin cancer. Acitretin offers protection against the development of basal cell and squamous cell carcinomas.
Patients who carry a high-penetrance melanoma predisposition gene can often benefit from screening for other cancers. Patients who receive a positive genetic test result are more likely to embrace prevention and detection measures. A new “Rules of Three” proposes a point-based guideline to help determine who should be referred for genetic counseling and testing.
The American Joint Committee on Cancer (AJCC) 8th Edition Melanoma Staging System includes important changes pertaining to T1 melanomas. The role of sentinel lymph node biopsy (SLNB) continues to evolve, particularly for thin melanomas. A contemporary international dataset is being applied to develop sophisticated and accurate personalized prognostic tools.
Melanoma rates continue to rise, especially thin lesions which represents the largest group of fatalities. Gene expression profile tests can help diagnose or predict melanoma and are easy to use. But many dermatologists do not follow recommended treatment guidelines, which indicates a need to either educate practitioners or rethink the guidelines.