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Black Hills Dermatologist Emphasizes Detection for Skin Cancer Awareness Month

Mar 29, 2018 06:00AM ● By MED Magazine

According to the Skin Cancer Foundation, more people in the US are diagnosed with skin cancer each year than all other cancers combined. More than 5.4 million cases of nonmelanoma skin cancer were treated in 2012 and an estimated 178,000 cases of melanoma will be diagnosed in the US in 2018.

Unfortunately, says Regional Health dermatologic surgeon Kim Phillips, MD, residents of the Black Hills may be especially vulnerable.

“It hits this geographic area harder in part because of our elevation and our sunny blue skies,” says Dr. Phillips. “Also, many people in this region tend to have fair skin and light eyes. That, along with the leisure activities and outdoor work that goes on here, means that people here are susceptible to premature aging and skin cancers.”

As with most cancers, early detection is the key to survival and Dr. Phillips says primary care physicians play a key role in that, as do patients themselves. Total body photography and handheld dermascopes have improved diagnostic precision, but some patients, such as solid organ transplant recipients, require special diligence.

“They may start developing skin cancer about 10 years after transplant and can actually die from their skin cancer before they would die from any complications related to their transplant,” says Phillips, who spent time with the transplant team at Mayo clinic. “So it is especially important to be proactive with these patients and to see them regularly. Primary care physicians can help keep these patients from falling through the cracks.”

Although skin cancer rates continue to rise, Dr. Phillips says there are now more effective options for treating both melanoma and nonmelanoma skin cancers.  

“There are lots of tools in the toolchest now,” she says. “The morphology of the tumor is very important, as is the site, whether or not the patient is immunocompromised, and whether or not it is a recurrent tumor.”

Among the tools in Dr. Phillips’ toochest are destructive therapies such as cryotherapy with liquid nitrogen or electrodesiccation and curettage (EDC). The immune response modifier Imiquimod and  fluorouracil (5FU) are examples of effective topical treatments. Larger tumors or those with a high risk of recurrence may require MOHS micrographic surgery, which has a high cure rate and good cosmetic results.

More complicated cases of basal cell carcinoma may benefit from systemic therapies such as the hedgehog pathway inhibitors vismodegib or sonidegib. Dr. Phillips says radiation may also be used in skin cancer treatment, though it is not typically a first-line therapy. But some of the best news is in one of the most serious cancers: melanoma.

“Twenty to twenty-five years ago, there was nothing in the toolchest to increase disease free survival,” says Phillips. “Now, we have all these families of molecular therapy. We are now seeing what are essentially tumor vaccines. We can look at specific tumor markers and create these very targeted treatments.”

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