The Role of Radiation, Immunotherapy, and Chemotherapy in the Management of Locally Advanced or Metastatic Cutaneous Malignancies

Abstract

Introduction: Skin cancer impacts a significant proportion of the population. While surgical management is often the mainstay of treatment, advanced or metastatic cutaneous malignancies require additional local and/or systemic therapies.

Methods: A review of the literature was performed studying the use of radiation therapy, chemotherapy, and immunotherapy for locally advanced or metastatic cutaneous malignancies.

Results: A summary of the present literature on the management of locally advanced or metastatic cutaneous malignancies is presented across cutaneous head and neck basal cell carcinoma, squamous cell carcinoma, melanoma, and Merkel cell carcinoma. The addition of multidisciplinary therapies to resection is often associated with improved outcomes.

Conclusion: The management of cutaneous head and neck malignancies requires an approach integrating multiple specialties, to optimize outcomes and minimize toxicities.

Keywords: Merkel cell; basal cell; cutaneous; immunotherapy; melanoma; radiotherapy; squamous cell; systemic therapy.

Figure 1

Hedgehog signaling pathway demonstrating pharmacologic inhibitors of the signaling cascade and its molecular targets [25].

Figure 2

Mechanism of action of PD-1 and PD-L1 inhibitors. Tumor cells express PD-L1, which interacts with PD-1 on T cells, inhibiting the T cells’ ability to attack the tumor cells (left). PD-1 and PD-L1 inhibitors block this interaction, allowing T cells to effectively eliminate tumor cells (right). PD-1 = programmed cell death protein 1; PD-L1 = programmed cell death ligand 1. For the National Cancer Institute © 2015 Terese Winslow LLC, U.S. Govt. has certain rights.