Previously, the only systemic medications for skin cancer were traditional chemotherapy agents for advanced or metastatic disease. These chemotherapies were not very specific and had many side effects. Over the past several years, several systemic agents have emerged to complement skin checks and surgery to help prevent skin cancer or treat advanced skin cancers. These medications are listed and described below.
Medications for skin cancer prevention:
- Nicotinamide (also known as niacinamide). This is a form of vitamin B3 and has been shown to reduce the development of basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs) by up to 23%. This supplement is usually taken twice per day (500mg).
- Acitretin. This is a systemic retinoid that help prevent skin cancers, especially SCCs. As this medication carries side effects such as skin dryness and requires lab monitoring because it can affect the liver and triglycerides (a type of fat in the blood), it is typically used for patients with higher skin cancer risk such as organ transplant patients.
Medications to treat melanoma:
- Immunotherapy. In the past decade, the development of immunotherapy medications has revolutionized cancer treatment for many types of cancers. Immunotherapy agents stimulate a patient’s own immune system to attack the cancer cells and are very commonly used for advanced melanoma that has spread to the lymph nodes or metastasized to other parts of the body. The most commonly used immunotherapy agents for melanoma are the PD-1 inhibitors pembrolizumab and nivolumab, which are sometimes combined with ipilimumab (a CTLA-4 inhibitor). These medications are all intravenous infusions administered by an oncologist.
- BRAF inhibitors. Melanomas that have a specific mutation (BRAF) are at times treated with medications that target this mutation (BRAF inhibitors- vemurafenib, dabrafenib, encorafenib). These medications are usually given in combination with a MEK inhibitor (trametinib, binimetinib, cobimetinib) to decrease side effects and the risk of developing SCCs. These medications are oral pills that are prescribed by oncologist.
Medications to treat basal cell carcinoma (BCC)
- Vismodegib and sonidegib. These are “hedge hog inhibitors” that block a cellular pathway that causes BCCs. Vismodegib is approved for both locally advanced (usually meaning very large and not able to be treated by surgery) and metastatic BCCs, and sonidegib is approved for locally advanced BCCs. These medications are daily pills but do have significant side effects including muscle pain, changes in taste, and hair loss. To decrease side effects, your physician may discuss alternate dosing regimens.
- Immunotherapy. Cemiplimab is a PD-1 inhibitor that is approved for patients with metastatic or locally advanced BCCs that have failed or are not able to take the above-mentioned hedge hog inhibitors (see above ‘Melanoma’ section for more information).
Medications to treat squamous cell carcinoma (SCC)
- Immunotherapy. Cemiplimab and pembrolizumab are both PD-1 inhibitors that are approved for metastatic or locally advanced (not able to be cured by surgery or radiation) SCCs (see above ‘Melanoma’ section for more information).