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!