Skin Cancer

  • Lisa Singer
  • Sue S. YomEmail author


Skin cancer is the most common malignancy in the USA and its incidence is increasing. Work-up, treatment, and relevant literature for major subtypes of skin cancer are discussed. Since the last edition, targeted therapies and immunotherapies have revolutionized skin cancer management, and these advances are also discussed.


Basal cell carcinoma Squamous cell carcinoma Merkel cell carcinoma Melanoma 



We thank Tania Kaprealian, MD, James Rembert, MD, and Lawrence W. Margolis, MD, for their work on prior editions of this chapter.


  1. Agrawal S, Kane JM, Guadagnolo BA, Kraybill WG, Ballo MT. The benefits of adjuvant radiation therapy after therapeutic lymphadenectomy for clinically advanced, high-risk, lymph node-metastatic melanoma. Cancer (Wiley Subscription Services, Inc., A Wiley Company). 2009;115(24):5836–44.Google Scholar
  2. Anwar M, Yu Y, Glastonbury CM, El-Sayed IH, Yom SS. Delineation of radiation therapy target volumes for cutaneous malignancies involving the ophthalmic nerve (cranial nerve V-1) pathway. Pract Radiat Oncol. 2016;6(6):e277–81.CrossRefGoogle Scholar
  3. Ganti AK, Macha M, Batra S. Profile of vismodegib and its potential in the treatment of advanced basal cell carcinoma. CMAR (Dove Press). 2013;5:197–203.CrossRefGoogle Scholar
  4. Atherton P, Townley J, Glaholm J. Cartilage: the “F-”factor fallacy. Clin Oncol. 1993;5(6):391–2.CrossRefGoogle Scholar
  5. Balch CM, Soong S, Ross MI, Urist MM, Karakousis CP, Temple WJ, et al. Long-term results of a multi-institutional randomized trial comparing prognostic factors and surgical results for intermediate thickness melanomas (1.0 to 4.0 mm). Intergroup melanoma surgical trial. Ann Surg Oncol. 2000;7(2):87–97.CrossRefGoogle Scholar
  6. Ballo MT, Bonnen MD, Garden AS, Myers JN, Gershenwald JE, Zagars GK, et al. Adjuvant irradiation for cervical lymph node metastases from melanoma. Cancer (Wiley Subscription Services, Inc., A Wiley Company). 2003;97(7):1789–96.Google Scholar
  7. Beadle BM, Guadagnolo BA, Ballo MT, Lee JE, Gershenwald JE, Cormier JN, et al. Radiation therapy field extent for adjuvant treatment of axillary metastases from malignant melanoma. Int J Radiat Oncol Biol Phys (Elsevier). 2009;73(5):1376–82.CrossRefGoogle Scholar
  8. Caccialanza M, Piccinno R, Gaiani F, Contini D. Relevance of dermatologic radiotherapy in the therapeutic strategy of skin epithelial neoplasms: excellent results in the treatment of lesions localized on eyelids and skin overlying the cartilage of the nose. G Ital Dermatol Venereol. 2013;148(1):83–8.PubMedGoogle Scholar
  9. Cascinelli N, Morabito A, Santinami M, MacKie RM, Belli F. Immediate or delayed dissection of regional nodes in patients with melanoma of the trunk: a randomised trial. WHO Melanoma Programme. Lancet. 1998;351(9105):793–6.CrossRefGoogle Scholar
  10. American Academy of Dermatology Ad Hoc Task Force for the ABCDEs of Melanoma, Tsao H, Olazagasti JM, Cordoro KM, Brewer JD, Taylor SC, Bordeaux JS, Chren MM, Sober AJ, Tegeler C, Bhushan R, Begolka WS. Early detection of melanoma: reviewing the ABCDEs. J Am Acad Dermat (Elsevier). 2015;72(4):717–23.CrossRefGoogle Scholar
  11. Chandra RA, Wilhite TJ, Balboni TA, Alexander BM, Spektor A, Ott PA, et al. A systematic evaluation of abscopal responses following radiotherapy in patients with metastatic melanoma treated with ipilimumab. Oncoimmunology (Taylor & Francis). 2015;4(11):e1046028.CrossRefGoogle Scholar
  12. Chen MM, Roman SA, Sosa JA, Judson BL. The role of adjuvant therapy in the management of head and neck merkel cell carcinoma: an analysis of 4815 patients. JAMA Otolaryngol Head Neck Surg (American Medical Association). 2015;141(2):137–41.CrossRefGoogle Scholar
  13. Cognetta AB, Howard BM, Heaton HP, Stoddard ER, Hong HG, Green WH. Superficial x-ray in the treatment of basal and squamous cell carcinomas: a viable option in select patients. J Am Acad Dermatol. 2012;67(6):1235–41.CrossRefGoogle Scholar
  14. Cognetta AB, Mendenhall WM. In: Cognetta AB, Mendenhall WM, editors. Radiation therapy for skin cancer. New York: Springer Science & Business Media; 2013.CrossRefGoogle Scholar
  15. Erovic I, Erovic BM. Merkel cell carcinoma: the past, the present, and the future. J Skin Cancer. 2013;2013(1):1–6.CrossRefGoogle Scholar
  16. Feng H, Shuda M, Chang Y, Moore PS. Clonal integration of a polyomavirus in human Merkel cell carcinoma. Science. 2008;319(5866):1096–100.CrossRefGoogle Scholar
  17. Gluck I, Ibrahim M, Popovtzer A, Teknos TN, Chepeha DB, Prince ME, et al. Skin cancer of the head and neck with perineural invasion: defining the clinical target volumes based on the pattern of failure. Int J Radiat Oncol Biol Phys. 2009;74(1):38–46.CrossRefGoogle Scholar
  18. Grimaldi AM, Simeone E, Giannarelli D, Muto P, Falivene S, Borzillo V, et al. Abscopal effects of radiotherapy on advanced melanoma patients who progressed after ipilimumab immunotherapy. Oncoimmunology. 2014;3(5):e28780.CrossRefGoogle Scholar
  19. Hanna E, Abadi R, Abbas O. Imiquimod in dermatology: an overview. Int J Dermatol. 2016;55(8):831–44.CrossRefGoogle Scholar
  20. Hasan S, Liu L, Triplet J, Li Z, Mansur D. The role of postoperative radiation and chemoradiation in merkel cell carcinoma: a systematic review of the literature. Front Oncol (Frontiers). 2013;3:276.Google Scholar
  21. Henderson MA, Burmeister BH, Ainslie J, Fisher R, Di Iulio J, Smithers BM, et al. Adjuvant lymph-node field radiotherapy versus observation only in patients with melanoma at high risk of further lymph-node field relapse after lymphadenectomy (ANZMTG 01.02/TROG 02.01): 6-year follow-up of a phase 3, randomised controlled trial. Lancet Oncol (Elsevier). 2015;16(9):1049–60.CrossRefGoogle Scholar
  22. Hernández-Machin B, Borrego L, Gil-García M, Hernández BH. Office-based radiation therapy for cutaneous carcinoma: evaluation of 710 treatments. Int J Dermatol (Blackwell Publishing Ltd). 2007;46(5):453–9.CrossRefGoogle Scholar
  23. Jaju PD, Ransohoff KJ, Tang JY, Sarin KY. Familial skin cancer syndromes: Increased risk of nonmelanotic skin cancers and extracutaneous tumors. J Am Acad Dermatol. 2016;74(3):437–51. quiz452–4CrossRefGoogle Scholar
  24. Jouary T, Leyral C, Dreno B, Doussau A, Sassolas B, Beylot-Barry M, et al. Adjuvant prophylactic regional radiotherapy versus observation in stage I Merkel cell carcinoma: a multicentric prospective randomized study. Ann Oncol. 2012;23(4):1074–80.CrossRefGoogle Scholar
  25. Karia PS, Jambusaria-Pahlajani A, Harrington DP, Murphy GF, Qureshi AA, Schmults CD. Evaluation of American joint committee on cancer, International Union against Cancer, and Brigham and Women's Hospital tumor staging for cutaneous squamous cell carcinoma. J Clin Oncol (American Society of Clinical Oncology). 2014;32(4):327–34.CrossRefGoogle Scholar
  26. Lacouture ME, Dréno B, Ascierto PA, Dummer R, Basset-Seguin N, Fife K, et al. Characterization and management of hedgehog pathway inhibitor-related adverse events in patients with advanced basal cell carcinoma. Oncologist. 2016;21(10):1218–29.CrossRefGoogle Scholar
  27. Locke J, Karimpour S, Young G, Lockett MA, Perez CA. Radiotherapy for epithelial skin cancer. Radiat Oncol Biol. 2001;51(3):748–55.CrossRefGoogle Scholar
  28. Lok B, Khan S, Mutter R, Liu J, Fields R, Pulitzer M, et al. Selective radiotherapy for the treatment of head and neck Merkel cell carcinoma. Cancer (Wiley Subscription Services, Inc., A Wiley Company). 2012;118(16):3937–44.Google Scholar
  29. Manyam B, Garsa AA, Chin RI, Reddy CA, Gastman B, Vidimos AT, et al. A multi-institutional comparison of outcomes of immunocompromised and immunocompetent patients treated with surgery and radiation therapy for cutaneous squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys. 2016;94(4):–948.CrossRefGoogle Scholar
  30. McDermott PN, Orton CG. The physics & technology of radiation therapy. Madison: Medical Physics Publishing Corporation; 2010.Google Scholar
  31. McDowell LJ, Young RJ, Johnston ML, Tan T-J, Kleid S, Liu CS, et al. p16-positive lymph node metastases from cutaneous head and neck squamous cell carcinoma: no association with high-risk human papillomavirus or prognosis and implications for the workup of the unknown primary. Cancer. 2016;122(8):1201–8.CrossRefGoogle Scholar
  32. Mendenhall WM, Shaw C, Amdur RJ, Kirwan J, Morris CG, Werning JW. Surgery and adjuvant radiotherapy for cutaneous melanoma considered high-risk for local-regional recurrence. Am J Otolaryngol (Elsevier). 2013;34(4):320–2.CrossRefGoogle Scholar
  33. Mojica P, Smith D, Ellenhorn JDI. Adjuvant radiation therapy is associated with improved survival in Merkel cell carcinoma of the skin. J Clin Oncol (American Society of Clinical Oncology). 2007;25(9):1043–7.CrossRefGoogle Scholar
  34. Morton DL, Thompson JF, Cochran AJ, Mozzillo N, Nieweg OE, Roses DF, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med (Massachusetts Medical Society). 2014;370(7):599–609.CrossRefGoogle Scholar
  35. Overgaard J, Gonzalez Gonzalez D, Hulshof MC, Arcangeli G, Dahl O, Mella O, et al. Randomised trial of hyperthermia as adjuvant to radiotherapy for recurrent or metastatic malignant melanoma. European Society for Hyperthermic Oncology. Lancet. 1995;345(8949):540–3.CrossRefGoogle Scholar
  36. Sause WT, Cooper JS, Rush S, Ago CT, Cosmatos D, Coughlin CT, et al. Fraction size in external beam radiation therapy in the treatment of melanoma. Radiat Oncol Biol. 1991;20(3):429–32.CrossRefGoogle Scholar
  37. Sekulic A, Migden MR, Oro AE, Dirix L, Lewis KD, Hainsworth JD, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012;366(23):2171–9.CrossRefGoogle Scholar
  38. Siegel RL, Miller KD, Jemal A. Cancer statistics, 2015. CA Cancer J Clin. 2015;65(1):5–29.CrossRefGoogle Scholar
  39. Sim FH, Taylor WF, Pritchard DJ, Soule EH. Lymphadenectomy in the management of stage I malignant melanoma: a prospective randomized study. Mayo Clin Proc. 1986;61(9):697–705.CrossRefGoogle Scholar
  40. Strom T, Caudell JJ, Han D, Zager JS, Yu D, Cruse CW, et al. Radiotherapy influences local control in patients with desmoplastic melanoma. Cancer (7 ed.). 2014;120(9):1369–78.CrossRefGoogle Scholar
  41. Swartz JL, Griffith KA, Lowe L, et al. Features predicting sentinel lymph node positivity in Merkel cell carcinoma. J Clin Oncol. 2011;29(8):1036–41.CrossRefGoogle Scholar
  42. Touzé A, Le Bidre E, Laude H, Fleury MJJ, Cazal R, Arnold F, et al. High levels of antibodies against merkel cell polyomavirus identify a subset of patients with merkel cell carcinoma with better clinical outcome. J Clin Oncol (American Society of Clinical Oncology). 2011;29(12):1612–9.CrossRefGoogle Scholar
  43. Veness MJ, Howle J. Cutaneous carcinoma. In: Gunderson LL, Tepper JE, editors. Clinical radiation oncology. 4th ed. Philadelphia: Clinical Radiation Oncology; 2016. p. 763–776.e2.CrossRefGoogle Scholar
  44. Veronesi U, Adamus J, Bandiera DC, Brennhovd O, Caceres E, Cascinelli N, et al. Delayed regional lymph node dissection in stage I melanoma of the skin of the lower extremities. Cancer. 1982;49(11):2420–30.CrossRefGoogle Scholar
  45. Wang JT, Palme CE, Morgan GJ, Gebski V, Wang AY, Veness MJ. Predictors of outcome in patients with metastatic cutaneous head and neck squamous cell carcinoma involving cervical lymph nodes: improved survival with the addition of adjuvant radiotherapy. Head Neck (Wiley Subscription Services, Inc., A Wiley Company). 2011;34(11):1524–8.Google Scholar
  46. Moore AY. Clinical applications for topical 5-fluorouracil in the treatment of dermatological disorders. J Dermatol Treat. 2009;20(6):328–35.CrossRefGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Radiation OncologyUniversity of Texas, MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of Radiation OncologyUniversity of California San FranciscoSan FranciscoUSA

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