Melanoma Treatment Advances Now Crossing into Other Skin Cancers

Deborah S. Sarnoff, M.D.

The treatment landscape for skin cancers has been transformed by recent approvals for immunotherapies, combinations of medications and new devices, said Deborah S. Sarnoff, M.D., president of the Skin Cancer Foundation, in an interview with Managed Healthcare Executive. These advances are starting to offer new options for patients with advanced basal cell carcinoma, squamous cell carcinoma and Merkel cell carcinoma.

The FDA’s December 2024 approval of a subcutaneous version of BMS’s Opdivo (nivolumab) represents a significant advancement, allowing patients to administer treatments at home rather than through hospital infusions.

“This is a major advantage because patients could theoretically dose themselves in the privacy of their own home, the way they do with GLP-1s such as Ozempic,” Sarnoff said.

Combination therapies, such as Regeneron’s Libtayo (cemiplimab) and Merck’s Keytruda (pembrolizumab), are creating new treatment possibilities for advanced skin cancers, including basal cell carcinoma and squamous cell carcinoma. Sarnoff said there is potential for using these treatments in metastatic Merkel cell carcinoma, an aggressive skin cancer.

“Metastatic Merkel cell is kind of a death sentence, but lately we have some of these immuno drugs that can be combined, or you can try one, and if it’s not working, you go to the next one,” Sarnoff said.

Tumor infiltrating lymphocyte (TIL) therapy also represents a key advancement for melanoma. This personalized medicine approach involves extracting immune cells from a patient’s tumor, multiplying them in a lab and returning them to the patient after chemotherapy. Amtagvi (lifileucel), which was developed by Iovance Biotherapeutics, was approved in February 2024 as the first cellular therapy to treat adults with unresectable or metastatic melanoma previously treated with other therapies.

“This is a breakthrough example of personalized medicine,” Sarnoff said, noting its potential for patients whose melanoma cannot be surgically removed.

But Sarnoff voiced skepticism about other therapies. For example, HPV vaccines such as Gardasil have shown inconclusive results when tested for skin cancer treatments. She also questioned the effectiveness of laser therapies for early or low-risk skin cancers.

"I don't think lasers at this moment, whether they're ablative or non-ablative, hold any good advantage for treating early or low-risk skin cancers," she said.

Radiation therapies are also evolving. Image-guided superficial radiation therapy is presented as a precise alternative for non-surgical candidates, though Sarnoff expressed uncertainty about its overall effectiveness due to the high number of required sessions. A newer radiation method, Alpha-DART (Diffusing Alpha Emitters Radiation Therapy), involving ultra-thin needles with radioactive seeds, has demonstrated promising preliminary results for recurrent squamous cell carcinoma and has received breakthrough device designation by the FDA.

For precancerous actinic keratoses, treatment is shifting toward addressing larger areas rather than isolated lesions, an approach Sarnoff strongly supports.

"If not, it's like you're playing whack-a-mole—you fix some and then more pop out," she said.

Recent FDA approvals have expanded topical treatments like Almirall’s Klisyri (tirbanibulin), allowing application to larger areas of affected skin, potentially improving patient outcomes.

"We really made great breakthroughs in the last few years for melanoma, that's for sure," she said. "The key now is making sure we don’t lose momentum."