Dermatological pharmacology in malignancies

Abstract

The main cutaneous malignancies are basal cell carcinoma, cutaneous squamous cell carcinoma, and malignant melanoma, which differ in prognosis, molecular features, metastatic potential, and cellular origin. Although surgery effectively treats most localized tumors, pharmacotherapy is important for superficial lesions, advanced disease, and reducing recurrence risk in high-risk melanoma. For superficial basal cell carcinoma, imiquimod and 5-fluorouracil provide non-surgical options, while advanced disease involving Hedgehog signaling can be treated with vismodegib or sonidegib. If Hedgehog inhibitors fail, cemiplimab can be used, while PD-1 inhibitors and other treatments such as cetuximab or chemotherapy are options for advanced cutaneous squamous cell carcinoma. Melanoma treatment has shifted from traditional chemotherapy to immune checkpoint inhibitors such as ipilimumab, nivolumab, relatlimab, and pembrolizumab, as well as BRAF/MEK inhibitors for BRAF V600-mutant disease. These therapies have improved outcomes, although treatment resistance, optimal sequencing, and immune-related toxicity remain important challenges.