Treatment of Disseminated Non-Melanoma Skin Cancers

Key Points

Basal cell carcinomas only rarely disseminate widely.
Squamous cell carcinoma of the skin has a variable risk of distant metastasis up to 16%.
Platinum-based combination therapy is used to treat both metastatic basal and squamous cell carcinoma; data from randomized trials are lacking.
Merkel cell carcinoma is an aggressive malignancy of the skin which frequently metastasizes. It is treated in a similar manner to small cell carcinoma of the lung, with platinum–etoposide combination regimens.
Targeted agents are being tested in these rare tumors, and this represents a promising area of research.

Introduction

Melanoma is a well-recognized and potentially invasive primary skin cancer, with comprehensive discussion in this textbook. However, other forms of skin cancer, particularly Merkel cell carcinoma, adnexal cancers and a percentage of squamous cell carcinomas, may also be regionally invasive or metastasize widely and become life-threatening. In the United States, over 2,000,000 cases of non-melanoma skin cancer are diagnosed yearly, and the incidence is increasing. Physicians are encountering larger numbers of patients with these tumors who also have metastatic disease. Management may be particularly difficult because reports of systemic therapy have tended to be anecdotal, clinical trials devoted to metastatic skin malignancies are few and not widely available, and the medical literature devoted to this topic is limited. This chapter reviews published data and provides an outline of the systemic approach to treatment of advanced non-melanoma skin cancers as practiced at MD Anderson.

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