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

In this video

Dr. Thosani reviews the familiar risk factors—fair skin and excess sun exposure, including incidental UVA "through the car windshield"—alongside environmental carcinogens like smoking, alcohol, and poor lifestyle habits. She flags high-risk squamous cell carcinomas as those larger than two centimeters or located on the lip or ear, especially in smokers and alcohol users, as well as tumors that are poorly differentiated or show perineural, lymphatic, or vascular invasion. Age and immunosuppression—organ transplant, or decades on methotrexate for rheumatologic conditions—raise concern further.

She walks through less common cancers worth recognizing: atypical fibroxanthoma and Merkel cell carcinoma present as reddish-brown nodules on sun-exposed skin of older patients (70+), while DFSP is an indolent, slow-growing tumor under the skin in younger patients (30–50) that "just feels different," like the princess and the pea—each requiring biopsy. On prevention, Dr. Thosani makes sun-protective UPF clothing the mainstay, adds sunglasses, and recommends nicotinamide (B3) twice daily, oral Polypodium leucotomos fern extract as "sunscreen in a pill," topical and oral antioxidants like vitamins C and E, and evening topical retinols as an adjunct.

  • Even without deliberate sun exposure, incidental UVA through car windows contributes to skin cancer risk—along with smoking, alcohol, and other carcinogens.
  • Treat squamous cell carcinomas on the lip or ear, larger than 2 cm, poorly differentiated, or with perineural, lymphatic, or vascular invasion as high-risk—and factor in age and immunosuppression.
  • AFX and Merkel cell carcinoma appear as reddish-brown nodules on sun-exposed skin in patients 70+; DFSP is an indolent subcutaneous tumor in younger patients aged 30–50. When a lesion doesn't fit, biopsy it.
  • Make UPF sun-protective clothing the mainstay of prevention rather than relying on sunscreen alone, and add sunglasses to protect the eyes.
  • Consider nicotinamide (B3) twice daily and oral Polypodium leucotomos, plus topical/oral antioxidants (vitamins C and E) and evening retinols to help reverse DNA damage and oxidative stress.