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  • Review Article
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Management of nonmelanoma skin cancer in 2007

Abstract

As the incidence of nonmelanoma skin cancer (NMSC) increases, so does the number of modalities used to treat this condition. Surgery is the most frequent approach used to treat NMSC, and clinicians usually perform Mohs micrographic surgery, conventional excision, electrodesiccation and curettage or cryosurgery. The 'gold standard' for treatment continues to be Mohs micrographic surgery, but owing to the time and expense involved with this procedure, it is indicated only in patients with aggressive tumors or those where disfigurement or functional impairment is a risk. Although radiation therapy is effective, its use is limited because of the side effects induced; radiation therapy can be used in certain patients who are not surgical candidates. Newer noninvasive options for NMSC include topical chemotherapeutics, biological-immune-response modifiers, retinoids, and photodynamic therapy, which can be used particularly in patients with superficial tumors. Treatments should be tailored to tumor type, location, size, and histological pattern, and although surgical methods remain the most frequently used, newer noninvasive treatments can be used in select tumors and may reduce morbidity.

Key Points

  • The incidence of nonmelanoma skin cancer (NMSC) continues to increase, and it is estimated that 20% of Americans will develop this type of cancer during their lifetime

  • The 'gold standard' for treating NMSC is Mohs micrographic surgery, although other surgical modalities such as excision or curettage and electrodesiccation are often very effective, less expensive, and can be the treatment of choice in certain circumstances

  • Radiation therapy is an effective treatment option, although side effects of this method and the cost limit its usefulness to cases involving nonsurgical candidates

  • Newer immune-modulating agents such as imiquimod have proven effective for treating superficial variants of NMSC and can be used in instances when other methods would be difficult to perform or where cosmesis is important

  • Photodynamic therapy is an emerging treatment for superficial NMSC, although it should not be used for thicker tumors

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Figure 1: Example of a basal-cell carcinoma in a patient with nonmelanoma skin cancer
Figure 2: Example of a squamous-cell carcinoma in a patient with nonmelanoma skin cancer
Figure 3: Schematic diagram of the management of nonmelanoma skin cancer
Figure 4: Patient with a basal-cell carcinoma
Figure 5: Treatment of a pigmented basal-cell carcinoma using Mohs micrographic surgery
Figure 6: Treatment of a basal-cell carcinoma with imiquimod

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Correspondence to David J Leffell.

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Competing interests

JA Neville completed a study sponsored by 3M Pharmaceuticals and has presented this work at symposia on behalf of this company. The other authors declared no competing interests.

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Neville, J., Welch, E. & Leffell, D. Management of nonmelanoma skin cancer in 2007. Nat Rev Clin Oncol 4, 462–469 (2007). https://doi.org/10.1038/ncponc0883

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