South Beach Symposium (SBS) co-chair, David J. Goldberg, MD, JD, led the Cutaneous Oncology Symposium at this year’s SBS. The over two-hour session featured a large variety of topics led by Dr. Goldberg and several other renowned dermatology experts. This included Laura K. Ferris, MD, PhD, Aaron S. Farberg, MD, and Todd E. Schlesinger, MD.
What’s the Differential Diagnosis?: Interactive Diagnosis Challenge
Dr. Goldberg kicked off the session with a discussion on differential diagnosis, reviewing the epidemiology of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC), and covering some of the risk factors associated with each. He also took participants through some clinical features of these diseases, highlighting certain characteristics. Dr. Goldberg went on to discuss some of the treatment methods currently available including Mohs surgery, hedgehog inhibitors, and superficial radiation therapy, which he covered more in-depth later in the session.
Artificial Intelligence and Detection
Dr. Ferris took to the stage to go through artificial intelligence (AI) and skin cancer diagnosis. She spoke about the differences that exist between humans and machines in the context of determining whether or not a lesion is benign or malignant, explaining the limitations of both. She mentioned the United States Food and Drug Administration (FDA) has oversight of AI devices, with only two currently being approved, Melafind and Nevisense, with the various apps available not being regulated by the FDA.
The topic of genetic testing was led by Dr. Farberg, in which he discussed melanoma staging and the guidelines that currently exist in relation to this. He looked specifically at 31-GEP, the 31-gene expression profile test for cutaneous melanoma, making reference to a study that demonstrated that patients tested with the 31-GEP had higher survival than untested patients at three years.
Best Practices in Managing AK
Dr. Schlesinger then took participants through managing actinic keratoses (AK), discussing a number of treatment options currently available for AK, such as cryotherapy, aminolevulinic acid photodynamic therapy, and topicals including 5-Fluorouracil and Imiquimod. He then examined multiple clinical cases, highlighting the recommended treatments for each case, before concluding with some emerging treatment options. He spoke specifically about the phase III trial results of 1% Tirbanibulin ointment which saw 49% of patients see complete clearance of lesions at 57 days. Dr. Schlesinger continued the discussion with the use of PD-1 inhibitors in BCC and SCC, reviewing some of his cases and what approaches he took for these patients.
Hedgehog Inhibitors for BCC
Dr. Farberg returned to cover hedgehog inhibitors for BCC, mentioning the difficult part of hedgehog inhibitors is the management of their side effects, specifically muscle cramps, taste alterations (dysgeusia), and hair loss. He shared some tips and tricks to manage these, the first being to decrease the dosing frequency, which he believes still shows optimal results. He also suggested the use of L-Carnitine for muscle cramps and the berry from a West African plant (synsepalum dulcificum), known as the ‘miracle fruit’ for dysgeusia. Dr. Farberg encourages physicians to expand their use of hedgehog inhibitors.
Advances in Melanoma
To conclude the session, Dr. Goldberg returned to the stage to speak about the advances in melanoma and superficial radiation therapy (SRT). He led participants through the risk factors for cutaneous melanoma including genetics and UV radiation. He then discussed the various types of primary melanomas before taking a closer look at superficial radiation therapy. He mentions that SRT is easy to administer and effectively targets and treats lesions, adding that it may be used to treat all skin surface areas. Additionally, SRT has a higher cure rate and is more cost-effective.