Skin Cancer xxix, 2011 : Page 54

HEALTH cancer rates. 7 To date, Capacetabine is FDA-approved only for metastatic colon, breast, and rectal cancers. Initial studies with skin cancer have had promising results; however, the studies are small, 5,6 so the risk/benefit ratio is undetermined. Capecitabine is being combined with subcutaneous interferon alpha, an immunotherapy, in some clinical trials. GDC-0449 otherwise healthy patients as well as those with basal cell nevus syndrome (who are highly prone to developing multiple BCCs). 9,10 This medication is not yet FDA-approved, but may prove revolutionary in BCC treatment. COMPARING NON-SURGICAL AND SURGICAL SKIN CANCER TREATMENTS cost of treatment, and the physician’s experience in that treatment. References available on p.96. DR. GOLDBERG , a fellow of the Royal College of Physicians, is a leader in Mohs micro-graphic surgery and the author of more than 250 publications on the subject. He was Chief of Dermatologic Surgery at Baylor College of Medicine, Houston, and is a Fellowship Director for the American College of Mohs Surgery and a past President of the Houston Dermatological Society. Dr. Goldberg is a staff member of The Methodist Hospital, in Houston. DR. MOODY is currently a clinical research fel-low for Dr. Goldberg. She received her medical degree with honors from UT Houston Medical School and will begin her Dermatology Resi-dency at UTMB in July 2011. MS. LANDAU is currently a clinical research coordinator for Dr. Goldberg. She received her Bachelor’s in Science with honors from Yale University and will begin medical school in the fall of 2011. DR. HOLZER is a fellow in Procedural Derma-tology at The Methodist Hospital, Houston. He received his MD with honors in research from the Weill Medical College of Cornell University and completed a dermatology residency at University of Alabama at Birmingham. GDC-0449 is a small molecule derived from cyclopamine, a chemical natu-rally produced by the corn lily that inhibits the body’s “hedgehog genetic pathway.” The hedgehog gene (Hh) is a signaling mechanism made up of proteins that carry developmental information to cells. Improperly func-tioning Hh pathways that overproduce the proteins have been implicated in the development of BCC and other skin cancers. 8 When taken orally, GDC-0449 stops the abnormal activity of Hh and prevents BCCs from growing in The majority of these options can be used to treat skin cancer patients who choose not to have surgery, are poor surgical candidates for health reasons, or for whom surgery will not be ef-fective. However, they can be quite expensive. If a patient is a suitable candidate for surgery, it would be hard to justify prolonged use of an irritating and less effective topical medication. When determining the preferred treatment, both patient and physician should take into consideration the type of tumor, the effectiveness of the treat-ment options, the risks of scarring and other side effects, the convenience or inconvenience of the techniques, the Non-surgical Treatment of Pre-cancers and Non-melanoma Skin Cancer Treatment Cryotherapy Indications Individual AK Lesions Superficial BCCs SCC in situ (noninvasive) Radiotherapy NMSCs Cure Rates 67.2–100% 1,11,12 Duration of Treatment 1–2 office treatments lasting seconds Most Common Side Effects Loss of pigment, redness, scarring, pain, blistering, crusting, oozing, ulceration Recurrence Rates * 1.2% 12 2.7% 15 0.8–2.9% 15 1–57% at 5–10 years 16 87–93% 13,14 96% 13,14 >90% 16 Varies Radiation inflammation, scarring, hair loss, broken blood vessels, risks of second skin cancer 5-FU 17 Superficial BCCs AKs SCC in situ 90% 87.8% 27–85% 50% complete response, 50% partial response (n=4) 43–100% 45–82% (with cycled approach) 73–88% 75–91% 80–100% 54% at least partial response; 33% stable disease 55.6% clinical, 0% histological (FLT) 21 2x daily for * 11 wks 2–4 wks 2x daily for 8 wks 950 mgm -2 body surface (days 1–14) with subcutaneous interferon 2x daily for 11 wks 2–3x per wk for up to 16 wks 1x daily for 12 wks A few treatments each year Redness, pain, inflammation, 11–15% after itching, scarring, crusting/scabbing 4–5 years 18,19 Capecitabine SCC (advanced) Prevention (in organ transplant patients) Fatigue, hand-foot syndrome, diarrhea Redness, swelling, weeping, itching, 16–20% at 24 months 20 loss of pigment, crusting/scabbing/ scaling, rawness, burning, pain, ulceration, tenderness, scarring Pain, burning, redness, blistering/ crusting Fatigue, chemical imbalance, muscle spasm, inflammation, weight loss Infection, loss of color, acne, cysts, scarring, pain, thinning of skin, erosions/crusting, redness, swelling, itching, and scaling 0–17% (SCC in situ), 6–31% (superficial BCCs) Imiquimod 17 Superficial BCCs AKs SCC in situ Photodynamic Therapy AKs Superficial NMSCs GDC-0449 BCCs (locally advanced, metastatic BCCs) 150mg daily until disease progression 4–5 Tx every 3–4 wks (non-ablative) * 1Tx (ablative) Laser Therapy AKs AK = actinic keratosis, NMSC = non-melanoma skin cancer, SCC = squamous cell carcinoma, BCC = basal cell carcinoma, SOTR = solid organ transplant recipient, FLT = non–ablative fractional photothermolysis 54 S K I N CA N C E R F O UND A T I O N J O URN A L

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