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Marie Bosslett is the assistant editor of 

 and joined the MJH Life Sciences team in October 2024. She attended Loyola University Maryland in Baltimore and earned a Bachelor of Arts in Communication with minors in marketing and writing. When she’s not writing, Marie enjoys going to concerts, reading on the beach, and spending time with friends and family.

Articles

The novel clinical trial compared the AAK cream to triple combination cream in treating patients with melasma.

Alpha-Arbutin and Kojic Acid Cream: Potential Treatment for Melasma

Maddi Hebebrand is an associate editor of 

and joined the MJH Life Sciences team in May 2024. She attended Baldwin Wallace University, studying Media Production and Film, and is now finishing her Masters in Digital Media through Ohio University. When she's not writing, Maddi loves to read, attend concerts and spend time with her family.

The study underscores the need for careful dietary advice to balance effective AD management and minimize food allergy risks.

Delphi Study Offers Insights on Food Allergy Testing in AD 

Patients achieved excellent new hair growth and strength when combining PRP with drug therapy after hair transplantation surgery. 

Platelet-Rich Plasma in Hair Transplantation Shows Success in Patients with Androgenetic Alopecia

and joined the MJH Life Sciences team in February 2023. She attended Kent State University and earned a Bachelor of Science degree in journalism with minors in public relations and creative writing. She enjoys making and listening to music, reading, and spending time with her cats, Astrid and Marceline.

The study is set to begin enrollment later this year.

Soligenix Launches European Advisory Board for Phase 3 HyBryte CTCL Trial

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Clinical

In this episode, we provide an update on a story we broke regarding benzene contamination being detected in various sunscreens and after-sun care products. Now, Johnson & Johnson has conducted its own internal testing and is recalling 5 different aerosol sunscreen products from Neutrogena and Aveeno. Listen as Christopher Bunick, MD, PhD, associate professor of dermatology, Yale University and 

 editorial advisory board member explains what this means for the sun protection industry and the next steps for the FDA.

Christopher Bunick, MD, PhD, provides an update on benzene contamination in sunscreen, including a recent recall from Johnson & Johnson. 

The Cutaneous Connection: Episode 27- Benzene Contamination Update

This episode will highlight some breaking news coming out of the sun protection world with a report by Valisure, which found in a recent test that 78 different sunscreen and after-sun care products were contaminated with benzene, a potential carcinogen.

The Cutaneous Connection: Episode 24- Benzene Found in Multiple Sunscreen Products

With the summer months quickly  approaching, we’re discussing the importance of skin cancer screenings, as well as encouraging regular sun protection usage among patients. This episode also touches on the role of telemedicine in skin cancer screenings, top product recommendations for sun protection and tips on managing patient expectations if the patient is diagnosed with skin cancer.  


The Cutaneous Connection: Episode 22- The Role of Sun Protection in Skin Cancer Prevention

In October's cover feature, Nicole A. Negbenebor, MD, FAAD, discusses the benefits of intralesional 5-fluorouracil injection for older patients with squamous cell carcinoma who may elect to delay therapy or are not ideal candidates for surgery.

Neoadjuvant Intralesional 5-Fluorouracil Injection: Improved SCC Treatment in Older Patients 

Farberg discusses data recently published in Geriatrics demonstrating low rates of recurrence.

Aaron Farberg, MD: Image Guided SRT Achieves High Cure Rates in Non Melanoma Skin Cancer

The study, published in Dermato, showed that 92% of NMSC tumors showed measurable changes in depth of invasion from one image to the next.

Q&A: Jeffrey Stricker, DO, MBA, Discusses Study on Image-Guided SRT in Non-Melanoma Skin Cancers

To improve overall outcomes for patients with large basal cell carcinomas, it has been beneficial to employ the use of vismodegib as a neoadjuvant and/or adjuvant treatment. 

Neoadjuvant and Adjuvant Vismodegib for Complex Basal Cell Carcinomas

Jacob Scott, MD, president and chairman of DaRT, shares highlights of the guidelines and what he hopes clinicians can glean from them.

Q&A: DaRT Guidelines for Nonmelanoma Skin Cancer Care

 Experts in dermatology discuss the clinical trial data from the BOLT and EVRIANCE clinical trials and review patient cases related to the management of patients with locally advanced basal cell carcinoma treated with sonidegib and vismodegib.

Jonathan S Zager, MD, FACS, FSSO reviews the clinical trial data relating to the BOLT study examining the use of sonidegib treatment in patients with locally advanced basal cell carcinoma, highlighting the critical differences in study design and data readouts between the BOLT and EVRIANCE trials.

Videos

Data Review of 2 doses of Sonidegib in Advanced Basal Cell Carcinoma (BOLT Trial)

Andrew Weinstein, MD, MPH, FAAD and Jonathan S Zager, MD, FACS, FSSO explore the potential rationale behind observed variations in the and GLI and PTCH expression data within the EVRAINCE trial and comment on potential factors contributing to bias within the study.

Expert Perspectives on EVRIANCE clinical trial data

Lilia Correa-Selm, MD, FAAD, FACMS, reviews the clinical trial data relating to the EVRIANCE study examining the use of vismodegib treatment in patients with locally advanced basal cell carcinoma, highlighting key efficacy and safety endpoints.

Data Review of the Efficacy and Safety of Vismodegib in Advanced Basal Cell Carcinoma (EVRIANCE Trial)

: The hedgehog pathway inhibitors, the oral medications have been approved for a longer period of time. I know the approvals for immunotherapy are a little bit newer. Although, we have experience with those medications for other skin cancers, so not new in our hands. We talk about immunotherapy for patients when hedgehog pathway inhibition is not appropriate. Are there cases where you go directly to immunotherapy?

: Yes. I think currently the way it is indicated is if the hedgehog pathway inhibitor is, if a patient is either intolerant or has progressed on it or who’s not appropriate. The question is who are these patients who may not be appropriate? Well, they may be patients who decline it, so they would be considered inappropriate. Either they’ve heard about the experience, they read about the adverse reactions, or for whatever reasons they decline it. I’ve also had 1 particular patient who had a lot of muscle cramps due to his MS [multiple sclerosis] and talking to his neurologist and the decision was he would not be appropriate for a hedgehog pathway inhibitor. We could shift and consider at that point immunotherapy or a checkpoint inhibitor. So there are just patients who are inappropriate. How about yourself?

I have found that the majority of my patients on hedgehog pathway inhibitors will have some side effect, either the muscle cramps that you mentioned, change in taste, or hair loss. For many patients, these are tolerable side effects, but they can be very wearing over a long course of treatment. My experience with immunotherapy is the majority of patients tolerate it very well, and only a very small number of patients have very significant side effects. Sometimes I’m discussing with the patient what their overall health status is, and we opt for immunotherapy because of other issues in their health. One thing I’m really keen to see in the future as we move towards immunotherapy as a presurgical or neoadjuvant in earlier stage melanoma, and we’re starting to see some research in squamous cell carcinoma. I think it would be a very interesting topic to address in immunotherapy. I know we and others had a small neoadjuvant presurgical trial with vismodegib , one of the hedgehog pathway inhibitors. I haven’t seen that yet for cemiplimab for the PD-1 inhibition, the immunotherapy for basal cell, but I’m hoping that’s something that could come next. Have you tried any neoadjuvant treatments?

: We have some experience with neoadjuvant more in for patients with squamous cell carcinoma and 1 patient with Merkel cell carcinoma. When they do respond, they respond very, very nicely. So it’s very encouraging also for basal cell carcinoma, the potential, or neoadjuvant for patients with advanced basal cell carcinoma. I guess, one of the questions is when we look at the data on checkpoint inhibitors for basal cell carcinoma, and we see the overall response rate. In a lot of these cases, patients have been heavily pretreated. They’ve had other treatment options, and then they respond. Some of the patients, they take a while to respond and then they respond. Then some patients may seem to have more stable disease. What’s the importance of stable disease for some of these patients in your opinion? How important is that?

: I think stable disease is incredibly important, particularly when we can keep a tumor from progressing that does threaten, you know, a vital function like vision, the eye, or a tumor that’s quite close to the mouth where ulceration might interfere with eating. If we can keep that from growing, give the patient both the benefit of better quality of life during that time and also a longer life expectancy. Stable disease as part of cancer management is sometimes underrated, particularly in really advanced tumors where we don’t have other options. One of the things I learned from the medical oncologists that I trained with is that stable disease can often give a patient time for the next blockbuster treatment to be invented and tested. So when we think about some of the patients with early melanoma treatments where we had nothing and now we have a lot, I’m hoping for basal cell cancer we’re going to this type of option developing rapidly as it has been.

: That’s wonderful. I totally agree and I share that viewpoint. I think it gives hope to continue on with their lives until either something else happens or until, you know. I agree. We don’t talk a lot about stable disease, but I think it is, if we can offer that, that’s wonderful.

: Four patients of mine who’ve had anxiety with entering the health care system and trusting doctors. I’ve also found that hands-on management and the time to develop that relationship is really important in building that trust for treatment.

: It takes time. It takes time to develop that relationship and that trust. I think one of the things we also don’t discuss is, even when we work in a multidisciplinary fashion and we do refer to the medical oncologist, our part doesn’t end really. We’re still the quarterback there. We’re still with the patient, and I do circle back with the patient even after tumor board, “Hey, did you see Dr so-and-so or doctor…so what do you think?” And it’ll be, “Yes. You know, I love that doctor you referred me to. I’m going to do that treatment. But he said also to follow up with you when I’m done,” and so we’ll make that appointment. We keep circling back because that’s the initial relationship and that’s where the trust is, and I think that that’s really key to maintaining those kind of long-term relationships because oftentimes those patients will need our long-term care.

Experts in dermatology comment on the patient considerations required when deciding on systemic treatment for basal cell carcinoma.

Considerations for Hedgehog vs Immunotherapy in Patients with Basal Cell Carcinoma

: Locally advanced basal cell cancer has really been an evolving definition over the past few years. How do you define those locally advanced tumors?

: That’s a great question. I think it’s still an evolving definition. I would say large infiltrative tumors, tumors that are recurrent following either surgery or radiation or multiple surgeries, are probably what I would consider locally advanced. Sometimes folks will mention resectable versus unresectable. Again, it depends on whose hands they may be unresectable. In my hands, as a Mohs surgeon, but maybe not so much in head and neck surgeon’s hands. If we’re talking about surgery being resectable and nonresectable, does it lead to any morbidity or deformity doing the surgery? If the answer is yes, then probably I would consider that a locally advanced case.

: So a tumor maybe near the eye where we could take it out, but would be sacrificing the patient’s vision is a nonsurgical approach may be better for the overall health of the patient?

: Correct. And of course, we always take into patient’s consideration. What would they like to do? How do they see it? Also, around that definition, I would consider a patient if he or she has multiple basal cell carcinomas where the tumor burden becomes very important—that overall high tumor burden. It may not be 1 locally advanced, but the sheer number of it makes it a little bit more challenging in terms of managing the patient.

: You mentioned resectable, unresectable, the idea that small basal cell cancer might be treated by a general dermatologist, one that’s more complex or on the face might require Mohs surgery, and then the ones that may invade deeper could involve other types of surgeons and maybe other options for treatment. When do you refer to other specialties?

: So, again, great question. I’ll consider a multidisciplinary approach or discussing these cases or calling one of my colleagues when one I feel it is not a Mohs case anymore. Or when the patient will say, “You know, I’ve had multiple surgeries. I’ve had radiation. What other options are there?” That’s when I start picking up the phone and I’ll start with my medical oncologist colleague, and I’ll say, “I’d like to refer this case. I’d like to discuss this. Can we add it to tumor board? Do you think we should get the radiation oncologists on board? Do you think the head and neck surgeon should be involved as well in this conversation?” That’s usually that point that I’ll kind of start making those phone calls. I tend to call or text my colleagues directly versus sending a referral or fax. I want to make sure that whoever I’m discussing the case with has a really good understanding of the patient, what the patient also is expecting.

: That’s terrific and great. It’s great when your physician has cell phone contact with their collaborating physicians and surgeons because I really think that type of doctor-to-doctor communication can really help with coordinating some of these complicated care patterns. In my practice, we’ve traditionally referred from surgery to radiation to systemic therapies. Now that we have more data on hedgehog pathway inhibitors and immunotherapies for advanced basal cell carcinoma, one thing I’ve been thinking about a lot is when I moved to systemic therapy earlier in the treatment course in situations where the surgery may be too morbid for the patient or the patient may be terrified to undergo radiation, which is a long and extensive course of treatment. Have you thought about using systemics earlier in some of these patients?

: Yes. Now that we have more options that are available in terms of systemic therapies, I do. I do. And I have that conversation with the patients where I’ll mention a couple of different systemic options in terms of, again, if it’s a locally advanced tumor, if the patient has had multiple surgeries or radiation and is maxed out on that, or as I mentioned earlier, multiple tumors. That high tumor burden where maybe 1 of the basal cell carcinoma is amendable, or 2 of them, but then they have so many. I’ve definitely had those cases and I refer them a little earlier onto systemic therapy. Again, I’ll call the medical oncologists and I’ll discuss the case and I think it makes it, like you said, it makes it a little bit clearer for everyone. We’re all getting on the same page.

Drs Sarah Arron and Nathalie Zeitouni share their insights into how they define locally advanced basal cell carcinoma and when they introduce multidisciplinary care.

Expert Insights Into Locally Advanced Basal Cell Carcinoma

: Welcome, everyone. My name is Nathalie Zeitouni. I’m a Mohs surgeon in Phoenix, Arizona. And Dr Arron and I are going to be having a conversation regarding management of basal cell carcinoma. So, Dr Arron.

: Hello, I’m Sarah Arron. I’m a dermatologist and a Mohs surgeon in Burlingame, California, and I’m delighted to chat with you today about basal cell carcinoma, Dr Zeitouni. I wanted to start by asking about your approach to newly diagnosed basal cell carcinoma and what options you discuss with your patients.

: I think that’s a great question. When a patient presents to our office or to our clinic, the first thing I usually go over is the diagnosis. What it means to have a basal cell carcinoma, so that the patient fully understands the diagnosis, the prognosis of the basal cell carcinoma. Then we go into the management, and I usually start with surgery. Most of the patients that are being referred to me are referred for Mohs surgeries. So is this an appropriate patient for Mohs based on the AUC [Appropriate Use Criteria]? Then I will also discuss perhaps some topicals as well if it’s a basal cell carcinoma that’s appropriate for some topicals. I do discuss radiation therapy and I do discuss systemic therapy if appropriate, again depending on the patient and depending on the tumor that we’re given. How about yourself? What are the approaches you handle?

: I do much the same. Again, from early superficial basal cells that can be treated with topical agents, all the way to basal cell cancers that are very extensive or have maybe recurred following multiple surgical interventions where we’re thinking about radiation or a systemic treatment. Sometimes patients are coming in with a delayed diagnosis. They don’t realize they’ve had a basal cell or they’ve had other health issues or obstacles to care for. Have you seen patients with complications of a delayed basal cell diagnosis?

: Yes. Unfortunately, that can happen for a variety of reasons, either they may not have had insurance and they’re concerned or they’ve had other things happen in their lives, which can happen. I’ve had 1 patient who her dermatologist has passed away, so she couldn’t find another dermatologist. It was a couple years before she circled back with one of us, and so there was this delay again in the diagnosis of the basal cell carcinoma. Fortunately, basal cell carcinomas, they grow slowly, but they do grow and sometimes they’re in areas that are hard for the patients to access or see on themselves. So, before you know it, they become more advanced, unfortunately. So definitely having a delay in diagnosis, there’ll be that progression. Most of the cases that we see are amendable to surgery and we do the Mohs surgery. But sometimes, that said, that delay in diagnosis, patients will present with more advanced tumors.

: What’s your experience with delay in diagnosis?

: I’ve had similar cases, particularly patients who have a lot of anxiety about medical care in general. Patients where the tumor gets quite large or symptomatic before a family member really pushes them to come in. Of course, we do have options, but when these tumors become locally advanced, they can be more complicated to treat.

Sarah Arron, MD, PhD, and Nathalie Zeitouni, MD, FAAD, discuss their approaches to managing patients with newly diagnosed basal cell carcinoma and highlight the negative consequences of a delayed diagnosis.

Management of Newly Diagnosed Patients with Basal Cell Carcinoma (BCC)

Experts in dermatology discuss treatment considerations for particular patient populations, highlighting the importance of managing adverse events aggressively.  

Treatment Considerations and Management of Adverse Events when Treating BCC

Experts in dermatology discuss the efficacy and safety combining hedgehog pathway inhibitors and immunotherapy as treatment for patients with basal cell carcinoma.

Efficacy and Safety of Combination Treatments for BCC

Todd Schlesinger, MD and Emily Ruiz, MD offer advice on forming multidisciplinary relationships for the wholistic study and treatment of basal cell carcinoma. 

Developing a Multidisciplinary Approach when Treating BCC

Emily Ruiz, MD and Todd Schlesinger, MD discuss treatment options for locally advanced basal cell carcinoma, such as immunotherapy and surgery.

Skin Cancer (Nonmelanoma)

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