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.
What Oral Medications are Available for Preventing Skin Cancer?
While protecting your skin against UV damage is the most important step for preventing skin cancer, there are oral medications that can supplement these efforts. This includes:
- 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.
What Oral Medications are Available for Treating Melanoma?
As one of the most aggressive forms of skin cancer, having various treatment options available for melanoma is important. Beyond radiation therapy or mohs therapy, other medical interventions include:
- 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.
What Oral Medications are Available for Treating Basal Cell Carcinoma?
Basal cell carcinoma (BCC) is the most common form of skin cancer in the US, attributing to 80 percent of new cases each year. Oral medications that can be used to treat BCC include:
- 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).
What Oral Medications are Available for Treating Squamous Cell Carcinoma?
Like other forms of skin cancer, squamous cell carcinoma (SCC) is treated using:
- 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).