Apoptosis-Based Skin Cancer Treatment Shows Promise

Christopher B. Zachary, MBBS, MRCP, FRCP, professor and chair emeritus of dermatology at the University of California, Irvine, discussed a novel treatment approach for basal cell carcinoma—apoptosis or programmed cell death—at the 2025 American Academy of Dermatology (AAD) Annual Meeting in Orlando, Florida.¹

Zachary, who has been working with a team at Henry Ford and UCI, explained that researchers have identified an optimal temperature range, around 53° to 55° for approximately 60 seconds, to induce apoptosis in cancerous skin cells without significant damage to surrounding tissue.

“All you get is just a little bit of elevation, a little bit of erythema-like appearance, which persists for about a week, gradually improving,” he told Dermatology Times. “Then, at about two weeks, you get an influx of new blood vessels, which appear clinically, and then at six months or so, there's very little in the way of scarring. And indeed, 9 out of 10 skin cancers, even with this rather crude system we have, will be histologically clear because we excised these at the end of 3 months after the last treatment and can demonstrate that these tumors have disappeared—9 out of 10.”

A significant advantage of apoptosis-based therapy is its non-invasive nature, he said, adding it will be an especially attractive option for older patients who may be less surgically inclined. Additionally, Zachary suggested that this treatment could become widely accessible: “Any qualified dermatologist will be able to do this technique,” he said, contrasting it with Mohs surgery, which requires specialized training.

However, barriers to adoption remain. Zachary noted that the process needs to gain FDA approval, and reimbursement concerns could delay widespread implementation. Unlike Mohs surgery, which is well-compensated, there is currently no dedicated CPT code for apoptosis-based treatments.

Zachary also voiced concerns about the overuse of Mohs surgery in the US,² arguing that many superficial basal cell carcinomas and squamous cell carcinomas in situ could be treated through non-Mohs techniques. “As a society, as a group of dermatologists, we should realize that Mohs is overdone,” he told Dermatology Times, acknowledging that his views might be controversial among Mohs surgeons. “I’m not against Mohs surgery. I’m very much pro-Mohs,” he clarified. “There are large cancers that are infiltrated, recurrent, or in critical anatomic areas—send those cases for Mohs, absolutely…What I’m against is doing fatuous, tiny areas that were probably removed with the shave biopsy and don’t need any Mohs. That’s overdoing it.”

Looking ahead, Zachary predicts a decade-long development process before apoptosis-based treatments reach widespread clinical use, similar to the trajectory of cryolipolysis for fat reduction. “We’ll see what happens in the future,” he told Dermatology Times. “Why don’t you come back to me next year?”

Read more from the AAD Annual Meeting from Dermatology Times.

References

1. Zachary CB. Advances in Devices to Treat Nonmelanoma Skin Cancer. Presented at the 2025 AAD Annual Meeting; March 7-11; Orlando, Florida.

2. Buchanan L, Brewer J. When to Call a Time Out on Mohs Surgery. Dermatology Times. May 7, 2023. Accessed March 15, 2025. https://www.dermatologytimes.com/view/when-to-call-a-time-out-on-mohs-surgery