Dr Todd Schlesinger on How Medical, Cosmetic, Research Dermatology Interact
Being a full-service practice for patients with skin cancer offering clinical research, medical treatment, and cosmetic procedures makes their lives easier, especially when they may not have other options, explained Todd Schlesinger, MD, FAAD, director, Dermatology and Laser Center of Charleston and Clinical Research Center of the Carolinas.
How do medical, cosmetic, and research dermatology intersect when a patient has skin cancer?
It really does interplay. Our medical patients oftentimes become research patients; our research patients become medical patients; both sides end up being cosmetic patients. I think it’s a continuum. For example, if someone has skin cancer, they may end up either having Mohs surgery or excisional surgery or whatnot. They may end up also in a study, after a surgery. They may end up going to the cosmetic area to have laser treatment, a follow-up to treat the scar to make that look nicer. It really all runs together.
I think having a practice that has the different components and sort of being a full-service practice for a patient kind of makes their lives easier as well. I think the research side of its unique and that we can offer something to those patients that may not have any other options, who are maybe looking for other options, maybe they’re uninsured and they don’t have treatment options that other patients might have, or they just are very interested in learning and how they can help other patients by participating in the trial.
So there’s lots of reasons why patients sort of move between one part of the practice and another, but it’s very comforting, I think, to be able to have all the components in one place.
How has the treatment of patients with advanced skin cancers changed over the years?
So this treatment of skin cancer has changed significantly over the past several years, primarily in the past 5 years, and some of the top developments in the treatment of these skin cancers have been the medical treatments. We’ve had Mohs surgery around for a number of years now, and it has undergone a slow advance and is doing very well in treating our patients that have tumors that are candidates for Mohs surgery. But for those patients who are not surgical candidates or maybe not radiation therapy candidates, for various reasons, we now have medical treatments for advanced skin cancer. And that’s really where most of the innovation has come.
A few years ago, we really didn’t have any approved therapies for squamous cell carcinoma that was locally advanced or metastatic, and now we have 2 treatments, 2 immunotherapy medications that are approved. So that’s been a paradigm shift from what we call traditional cytotoxic chemotherapy. Think paclitaxel and radiation, epidermal growth factor receptor inhibitors, think cetuximab medications—things like that were used to treat squamous cell carcinoma that was cutaneous in origin but never approved. So I think the approval of immunotherapy has been a big advance.
The increased experience that we have with the hedgehog pathway–inhibiting medications is also an advance. So hopefully we’ll continue to see a targeted approach to the treatment of skin cancer, with new developments and new research that is looking to enhance the benefits and the outcomes of immunotherapy, looking to treat the patients that are maybe resistant to those therapies that aren’t responding or for whatever reason are maybe progressing on those therapies.