Beyond the Knife: Practical Nonsurgical Options for Skin Cancer

In Episode 64 of Derms and Conditions, our host, Dr James Q. Del Rosso sits down with Dr

Shane Chapman, Chair of the Department of Dermatology at Dartmouth Hitchcock Medical

Center, to discuss nonsurgical approaches to treating nonmelanoma skin cancer. 

Dr. Chapman begins by discussing topical treatment options for nonmelanoma skin cancer for

patients who are not candidates for surgery. He comments on the use of intralesional

chemotherapy for keratoacanthomas or squamous cell carcinomas in poorly healing areas or

when multiple lesions are present, compares the benefits of 5-fluorouracil and intralesional

methotrexate, and explains the benefits of using oral acitretin with intralesional therapy.

The pair then discuss intralesional methotrexate in more detail, explaining how methotrexate

and 5-fluorouracil can be interchanged or used in combination with PDT to treat

keratoacanthomas/squamous cell carcinomas. They also discuss how to approach a case of a

patient with a nodular basal cell carcinoma on her nasal tip who refuses treatment with surgery

or radiation.

Next, they discuss treatment of broader skin lesions, such as superficial or multifocal basal cell

carcinomas and detail imiquimod, 5-fluorouracil, and both red and blue light PDT as potential

treatment options.

To conclude, they discuss how to manage brisk imiquimod responses and the impact on

treatment duration. Tune into this episode to hear the full details and learn more!