Rebecca Hartman, MD, discusses key points from her lecture, Non-Melanoma Skin Cancer: Outcomes and Quality of Life, at the 6th Annual Elevate-Derm Alliance Fall Conference at the JW Marriott Water Street in Tampa, Florida.

In this video

Dr. Hartman describes using topical treatment as first line for certain low-risk cancers — squamous cell carcinoma in situ and superficial basal cell carcinoma. A recent study supports the combination of 5-fluorouracil and calcipotriene for SCC in situ, which she applies twice a day for five to 10 days, a much shorter course than the four to six weeks of 5-FU alone, with response rates reported around 90%. For superficial basal cell carcinoma she still leans on imiquimod given the supporting data, dosed five nights a week for four to six weeks. For field cancerization, the same combination cream twice daily for five days treats actinic keratoses and reduces future non-melanoma skin cancer risk — "a double win" with better compliance and, per a UK satisfaction survey, less irritation than 5-FU monotherapy.

Active surveillance, she emphasizes, hinges on both the lesion and the patient: she has to be confident what the lesion is (a small, sub-centimeter nodular basal cell with clear-cut dermoscopy features like arborizing vessels, away from high-risk sites), and the patient — often elderly with limited life expectancy — has to be in agreement. "The key word is active," she notes: you can always sample or excise later. On nicotinamide, an oral vitamin B3 analog shown to cut skin cancer risk by about 25%, she is using it more since VA studies confirmed the benefit (greatest when started early) and showed no increased cardiovascular risk. She typically waits until a patient has had two skin cancers before offering it.

  • For SCC in situ, combination 5-fluorouracil and calcipotriene twice daily for 5–10 days is a shorter, well-tolerated course than 5-FU alone, with ~90% response.
  • For superficial basal cell carcinoma, imiquimod five nights a week for four to six weeks remains her go-to given the supporting data.
  • Topical therapy for low-risk cancers spares patients surgery — and if it fails, there's still room to try another treatment.
  • Active surveillance is a joint decision reserved for clearly identified, small, low-risk lesions in patients who are amenable — often elderly with limited life expectancy.
  • Oral nicotinamide reduces skin cancer risk ~25%, works best started early, and VA data show no increased cardiovascular risk; she considers it after a patient's second skin cancer.