The Future of Non-Invasive Skin Cancer Removal

Orit Markowitz, MD, is a board-certified dermatologist and the founder of OptiSkin. At the 2023 Society of Dermatology Physician Assistants (SDPA) Annual Summer Dermatology Conference, Markowitz joined clinician Brad Glick, DO, MPH, to present a session on minimally and non-invasive methods of skin cancer removal and treatment.

Markowitz spoke with Dermatology Times® to discuss the highlights of the session, "Innovative Skin Cancer Treatments: Beyond the Surgical Cut," recommendations for best practices in non-invasive skin cancer treatment, and the future of bandaid-free skin cancer removal.

Orit Markowitz, MD: Hi, I'm Dr. Orit Markowitz, the founder of OptiSkin in Manhattan. I'm a board-certified dermatologist who specializes in imaging and non-invasive management of skin cancer, as well as early diagnosis. OptiSkin, or the optics of skin, focuses on non-invasive imaging, and we do a lot of both clinical trials and managing patients with innovation. I'm affiliated with SUNY Downstate Medical Center in Brooklyn, as well.

Dermatology Times: What are key highlights from your session, "Innovative Skin Cancer Treatments: Beyond the Surgical Cut?"

Markowitz: This session is about treatment of skin cancer non-invasively. I think many sort of feel that photodynamic therapy and superficial radiation therapy are sort of the go-tos in that space, and I will be presenting on everything else, so just to be aware that there are other options. And skin cancer, like any other skin disease, isn't just one version that fits for one type of treatment, and so there are lots of options. I'll talk about some of the work that that I've done on this for the last 20 years.

Dermatology Times: What are the benefits of using non-invasive lasers to remove skin cancer?

Markowitz: First off, I would say part of it is: One of the issues that we have is when patients think that they have to have pretty significant surgeries to manage skin cancer, they end up working almost to the opposite, and ensuring that, because they become really frightened, they don't want to come in for skin exams, they start avoiding their providers. And so when we start to open the conversation, and talk about ways to manage skin cancer less invasively, it hopefully motivates patients to come in and get examined, because if we can catch things very early, we have a lot more opportunity to manage them less invasively.

Dermatology Times: How often is it that a patient's skin cancer can be removed non-invasively as opposed to traditional removal?

Markowitz: Everything depends on what kind of cancer, and also the stage and location.

But with the majority of basal cells, given oral therapy, topicals lasers, non-invasive imaging to monitor these lesions, I've been pretty successful with the entire gamut of basal cells, in terms of finding non-invasive options. And then if needed, you can always have a much smaller surgical removal. But I've been able to remove the majority of these without surgery, even some very advanced tumors.

I would say with melanoma, we're obviously going to be much more cautious, given how deadly it can be. However, there is quite a bit of research, and I've also followed that research in managing some of the melanoma in sitos on face and scalp where patients don't want to have very large surgical removals, non-invasively. But we do combine it with non-invasive imaging.

And then with squamous cell, you also have to be really careful because in the US, there are more deaths from squamous cell each year than melanoma. But with stage 0 in certain locations, and really strong monitoring, patients do have options to manage these things and not have to deal with some more aggressive modalities like surgery, etc.

I think it's important to remember we have a lot of innovations in the skin cancer space. If you think about where skin cancer treatment began, Frederic Mohs came up with Mohs surgery in the 1960s. Prior to that, it would basically be very advanced lesions that you could diagnose from across the room, and really aggressive surgeries with really poor prognosis. And now, we're [in] 2023; we're quite a few years past that. Present day Mohs was innovated in the 1980s. So if you think about that, that's 40-plus years ago. So with non-invasive technologies, with various medications, and also with all of the new innovations with lasers, patients, many of my patients are diagnosed, treated, and go home without a bandaid.

[Transcript edited for clarity]