Maya Thosani, MD, discusses her lecture "Challenging Non-Melanoma Skin Cancer Management " on Thursday, November 7, 2024, at the 5th Annual Elevate-Derm West Conference at the Westin Kierland Resort in Scottsdale, Arizona.

In this video

In conversation with a dermatology PA advisory board member, Dr. Thosani walks through three challenging non-melanoma skin cancer cases. The first involved a gentleman with a history of squamous cell carcinoma whose previous surgeon operated on the wrong site, with devastating consequences compounded by delayed treatment and active, poorly controlled CLL. Her takeaway: partner with your patient and be their best advocate — confirm the surgeon reviews the photographs and location, and have the patient look in a mirror and point to the spot to help prevent wrong-site surgery. The second case, a large tumor she felt was not operable under local anesthesia, showcased the value of a multidisciplinary approach — plugging the patient into primary care for screening labs and looping in medical and radiation oncology so the whole team has a game plan for imaging, follow-up, and adjuvant treatment. As she puts it, "reaching out for help is never the wrong answer."

Her final case addressed CTCL, which she calls "a great mimicker" that can look like any scaly rash and often takes years to diagnose because it is so subtle under the microscope. She recommends at least three biopsies — in her hands, two broad shaves and a punch — plus noting on the requisition that she wants the pathologist to consider CTCL and providing clinical photos. She also notes that in skin of color, CTCL can present variably, mimicking pityriasis alba, ashy dermatosis with a bluish-grayish hue, or psoriasis-like plaques, so when patients aren't responding to standard therapies, dig a little deeper.

  • Partner with and advocate for your patient — confirm the biopsied site is the one being treated, and have patients point to the spot in a mirror while the surgeon reviews photographs to prevent wrong-site surgery.
  • Encourage patients not to delay treatment; delays plus underlying conditions like active CLL can turn a manageable situation devastating.
  • For large or inoperable tumors, use a multidisciplinary approach — establish primary care for screening labs and surgical fitness, and involve medical and radiation oncology for a coordinated plan on imaging, follow-up, and adjuvant treatment.
  • CTCL is a great mimicker; obtain at least three biopsies (Dr. Thosani favors two broad shaves plus a punch), note "consider CTCL" on the requisition, and provide clinical photos.
  • In skin of color, CTCL may look lighter (mimicking pityriasis alba), show an ashy/bluish-gray hue, or present as subtle discoloration — think of it when patients aren't responding to standard therapies.