Corey Hartman, MD, FAAD, talks about trends and issues to watch in 2024 in the subspecialty of skin cancer.
One exciting development is the CellFX system, which is a method of nano pulse stimulation. What makes CellFX unique is that it targets cells that makeup benign lesions that can lead to skin cancer in the future. If we can use a tool that can minimize the instances of skin cancer in our patients, it’s incredibly exciting. CellFX is a nonthermal procedure that applies ultrashort pulses of electric energy to trigger regulated cell death in treated tissues, while sparring non-cellular collagen foundation on the skin. The procedure specifically targets these cells while preserving healthy tissue and cells around the benign lesion. This differs from cytotherapeutic procedures that kill all tissues and cells, even healthy ones. The CellFX procedure is quick and relatively painless, so patients can resume normal activity immediately following their appointment. Overall risks of scarring is low with the procedure and the procedure sites heal naturally, leading to healthy skin.
There is also promising research that suggests that photodynamic therapy (PDT) for pigmented basal cell carcinoma paired with combination techniques that make the PDT therapy more effective. Traditionally, PDT therapy poses challenges for treating pigmented basal cell carcinoma since human skin itself absorbs and scatters light, especially with hemoglobin and higher levels of melanin in the skin. Eumelanin absorbs light effectively and can neutralize PDT-induced ROS, which decreases the success of PDT therapy in these patients. However, this research suggests that pairing curettage or debulking prior to PDF can increase success of the treatment of pigmented basal cell carcinoma. Having another option to treat basal cell carcinoma in Black and Brown patients is always an important development.
So far, I’ve found the integration of AI and machine learning related to skin cancer treatment disappointing. Research published in the Journal of the European Academy of Dermatology and Venereology from October 2023 found that ChatGPT did not perform as well in the context of actinic keratosis. The research indicated that ChatGPT only provided accurate, current, and complete responses to 31.6% of questions related to patient education, diagnosis and treatment. That number is alarmingly low when you’re talking about skin cancer. ChatGPT performed its best specific to patient education 57.9% of the time, which is still a low number. The research also noted that some of the responses conveyed alarming information unnecessarily, which is the opposite goal of what we as professionals try to do when speaking to patients about skin cancer treatment.
We use chat platforms like Klara to connection patient photos, but I don’t perform remote consultations since I am primarily a procedural dermatologist. I do think telemedicine and remote consultations can be a benefit for patients, especially if they are not local to the dermatologist, to begin a conversation to determine if the dermatologist is a good fit, and what treatment options exist for their particular needs.
I am not a fan of natural products specific to treating skin cancer. Natural products have their place if patients are interested in them, but not when treating cancer. Some of these natural products, like Black Salve, have these outrageous claims that it can “draw out cancer.” These claims are misleading and dangerous – Black Salve has never been proven to work to treat skin cancer. Some governments are even going so far as to put out campaigns to inform its citizens that Black Salve will not treat cancer. Australia is actively creating alerts that advise people not to purchase Black or Red Salves to treat cancer. Skin cancer, if found early, can successfully be treated with medical intervention. Cancer is not a condition to leave to unproven natural therapies.
I’m following the work that is being done on melanoma therapies. Melanoma is the deadliest form of skin cancer and advanced forms of melanoma are quite threatening to life. The FDA recently approved the combination of two immunotherapy drugs (relatimab and nivolumab,) for certain types of advanced melanoma. Relatlimab works by blocking proteins on immune cells Lag-3 and nivolumab blocks PD-1, a different protein found on immune cells. By blocking both of these proteins, the treatments help unlock an immune response against deadly melanoma cancer cells. It is the first systemic treatment a patient could receive after an advanced melanoma diagnosis.
Dr. Hartman reports no financial interests.
Corey Hartman, MD, FAAD, talks about trends and issues to watch in 2024 in the subspecialty of skin cancer.