Update in Skin Cancer


SKIN CANCER UPDATES

Associate Professor Sasima Eimpunth, MD

Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok, Thailand


Pamela Chayavichitsilp, MD

Faculty of Medicine Ramathibodi Hospital, Mahidol University, Bangkok, Thailand


Rasthawathana Desomchoke, MD

Chulabhorn Hospital, Chulabhorn Royal Academy, Bangkok, Thailand


Assistant Professor Marisa Pongprutthipan, MD

Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand


SYNOPSIS

Skin cancer is a worldwide health issue and the incidence is on the rise globally. Skin cancer may arise from any cell type within the skin such as keratinocytes (cells of the epidermis), melanocytes (pigment-producing cells), or fibroblasts (fiber-producing cells). The 3 most common skin cancers are basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma (MM) with BCC being the most common and MM being the most invasive type of skin cancer.(1)  

Because the skin is an organ that is visible to the eye, screening is of paramount importance as it enables early detection, early treatment and thereby higher cure rates. In the recent years, the public has been made aware of skin cancer protection as well as self-detection due efforts by several organizations in many countries. Our session aims to discuss updates in skin cancer from diagnosis to management. Discussions will involve not only knowledge for physicians in providing appropriate care, but also technological advancements in self-detection on the patient side. The session includes 4 distinct topics as shown below:

Dermoscopic Diagnosis of Skin Cancer

The gold standard for skin cancer diagnosis is microscopic evaluation from the excised tissue.(1) If there exists a suspicious lesion, the lesion should individually be biopsied and tissue sent for histopathological diagnosis in order to decide on an appropriate treatment. Unfortunately, not all patients can tolerate undergoing a biopsy for every suspicious lesion. In cases with conditions such as organ-transplants, chronic arsenicism or xeroderma pigmentosum, numerous skin cancers or premalignant lesions are typical. Hence, any non-invasive method that can help differentiate benign from malignant tumors, can be beneficial.

Dermoscopy, or dermatoscopy, is the use of a dermoscope, or a dermatoscope, which is an instrument with a magnifying lens and a light source used to visualize skin lesions and determine the type of lesions from the patterns observed. It cannot be used as a substitution for the gold standard of biopsy with microscopic examination. However, patterns under dermoscopy can be used to help rule out or rule in skin malignancies in many cases, thus avoiding unnecessary biopsies.(2) The dermoscopic patterns in the diagnosis of skin cancers will be introduced and discussed in this lecture. 

Skin Cancer Mobile Apps: Do they work?

Screening for skin cancer has traditionally been performed by dermatologists. However, due to the rise of incidence of skin cancer globally, public awareness has become more apparent. In the age of smart phones, many providers are creating applications to help screen for skin cancers from photographs. These applications are becoming more widely used in the general population, particularly the younger generation that is familiar with using smart phone applications in their daily routine. This talk will discuss the available applications and their accuracy in screening skin cancers keeping in mind no apps will replace a thorough skin check by a board-certified dermatologist. 

Liquid biopsy: A nouveau monitoring technique in melanoma patients

Recently, circulating tumor (ctDNA) detection has been used as a noveau biomarker for monitoring disease status of patients with late stage cancer. In melanoma, ctDNA demonstrates a clinical benefit as another option of tumor recognition for treatment analysis. Aged systemic agents have been replaced by modern first-line therapies, such as anti-CTLA4 and anti-PD1as well as others targeted therapies. Therefore, it is important for oncodermatologists to have predictable and decisive tools for monitoring disease progression. 

Localized and advanced stages of melanoma are known to produce circulating tumor cells and tumor DNA (ctDNA) that can be identified and measured from peripheral blood specimens. This “liquid biopsy” technique will help physicians decide on the precise treatment options, particularly in the case of mutation-based targeted therapies. The use of this nouveau technique and its criteria for the phenotypic analysis of circulating melanoma cells or their fragments as well as the instability of ctDNA in blood will be discussed in this talk. 

Basal Cell Carcinoma and the Need of Mohs Micrographic Surgery

Basal cell carcinoma (BCC) is the most common type of skin cancer. In Thailand, treatment of BCC can be easily performed in an outpatient setting. This includes electrodessication and curettage, cryotherapy and wide excision in early stages of disease. In aggressive variants of BCC such as sclerosing, micronodular and those with perineural involvement, these modalities of treatment may be inadequate since negative pathological margins may not translate to complete clearance of the tumor.

Mohs micrographic surgery (MMS) is a staged excision with tissue margin examination and is now considered the recommended treatment modality in BCC given its the lowest rate of recurrence compared to other methods. Because of its high operating costs and time-consuming nature, less than ten medical facilities perform MMS in Thailand. This lecture will discuss MMS and provide the appropriate referral indications to optimize treatment outcomes as well as cost efficiency. 

References

  1. Ponten F, Lundeberg J, and Asplund A. Principles of tumor biology and pathogenesis of BCCs and SCCs. In Callen JP, et al (editors): Dermatology; 2nd eds (2008): Mosby Elsevier (Spain) page 1627-1639.
  2.  Kittler H, et al. General principles. In Kittler H, et al. (editors): Dermatoscopy: An algorithmic method based on pattern analysis; (2011): facultas.wuv (Austria) page 9-24. 

 

Event Hours(1)

  • Convention Hall A.

    03:00 pm – 04:30 pm

    Speakers:
    1. Dermoscopic Diagnosis of Skin Cancer
    Asst. Prof Sasima Eimpunth (SI)
    2. Skin Cancer Mobile Apps: Do they work?
    Dr. Pamela Chayavichitsilp (Rama)
    3. Liquid biopsy: A Nouveau monitoring technique in melanoma patients
    Dr. Rasthawathana Desomchoke (CRA)
    4. Basal Cell Carcinoma and the Need of Mohs Micrographic Surgery
    Asst. Prof. Marisa Pongprutthipan (CU)

    Moderator:
    Dr. Pamela Chayavichitsilp (Rama)

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