Treatment Of Nonmelanoma Skin Cancer Research Articles

Surgery in the Era of Immunotherapy for Advanced Head and Neck Non-melanoma Skin Cancer.

Surgery remains the mainstay of treatment for non-melanoma skin cancer (NMSC). Immunotherapy (IO) has emerged as an alternative option. This review provides a contemporary summary of how to incorporate IO into the management of advanced NMSC. Evidence-based outcomes and recent clinical trials are provided with emphasis on the three most common NMSC diagnoses: cutaneous squamous cell carcinoma (cSCC), basal cell carcinoma (BCC), and merkel cell carcinoma (MCC). Surgical resection while preserving form and function remains the standard of care for the majority of NMSCs. In recalcitrant cases failing traditional surgery and/or primary radiation, patient ineligible for such treatments, or unresectable disease, IO has emerged as a promising alternative. In the majority of cases, it is a supplanting primary chemotherapy. Surgery remains the standard of care for NMSC. Immunotherapy has emerged as an alternative option for non-surgical candidates and as a neoadjuvant means to minimize morbidity.

Immunomodulators for Non-Melanoma Skin Cancers: Updated Perspectives.

Non-melanoma skin cancers (NMSCs) are the most common cancers worldwide and may be associated with significant morbidity and mortality, especially in immunosuppressed populations. Successful management of NMSC must take primary, secondary and tertiary prevention strategies into consideration. In response to an improved understanding of the pathophysiology of NMSC and associated risk factors, multiple systemic and topical immunomodulatory drugs have been developed and integrated into clinical practice. Many of these drugs are efficacious in the prevention and treatment of precursor lesions (actinic keratoses; AKs), low-risk NMSC, and advanced disease. The identification of patients at high risk for the development of NMSC is critical in reducing disease morbidity. Understanding the various treatment options available and their comparative effectiveness is paramount for developing a personalized treatment regimen for such patients. This review article provides an updated overview of the various topical and systemic immunomodulatory drugs available for the prevention and treatment of NMSC, and the published data supporting their use in clinical practice.

Lip Reconstruction After Mohs Micrographic Surgery: A Guide on Flaps

The lips are commonly affected by skin cancer because of increased sun exposure over time. Even with early detection, many of these skin cancers require surgical removal with subsequent reconstruction. Mohs micrographic surgery is the preferred method of treatment for nonmelanoma skin cancers of the lip, as it has the lowest recurrence rates and allows for the maximum preservation of healthy tissue. After surgery, the remaining lip defect often requires reconstruction with skin grafts or a local cutaneous or myocutaneous flap. There are several local flap reconstruction options available, and some may be used in combination for more complex defects. We provide a succinct review of commonly utilized flaps and outline their indications, risks, and benefits.

Dilute Intralesional 5-Fluorouracil for the Treatment of Squamous Cell Carcinomas and Keratoacanthomas: A Case Series.

Intralesional 5-fluorouracil (5-FU) is a promising, yet sparsely studied alternative to surgical treatment for nonmelanoma skin cancer (NMSC).1 Previous studies of intralesional 5-FU have reported concentrations ranging from 30 to 50 mg/mL. To the best of our knowledge, this case series represents the first reported use of intralesional 5-FU 10.0 mg/mL and 16.7 mg/mL for NMSC. A retrospective chart review identified 11 patients who received intralesional 5-FU 10.0 mg/mL and 16.7 mg/mL for 40 cutaneous squamous cell carcinomas and 10 keratoacanthomas. We describe the characteristics of these patients and calculate the clinical clearance rate of dilute intralesional 5-FU therapy for NMSC at our institution. Dilute intralesional 5-FU successfully treated 96% (48/50) of the study lesions, providing complete clinical clearance in 82% (9/11) of patients across a mean follow-up time of 21.7 months. All patients tolerated their treatments well with no reported adverse effects or local recurrences. The use of more dilute preparations of intralesional 5-FU for NMSC may be a means of reducing cumulative dose and dose-dependent adverse reactions while maintaining clinical clearance. J Drugs Dermatol. 2023;22(5): doi:10.36849/JDD.5058.

Years of dermatology experience and geographic region are associated with outlier performance of excision or destruction for nonmelanoma skin cancer

IntroductionTreatments for nonmelanoma skin cancer (NMSC) include excision (surgical removal) and destruction (cryotherapy or curettage with or without electrodesiccation) in addition to other methods. Although cure rates are similar between excision and destruction for low-risk NMSCs, excision is substantially more expensive. Performing destruction when appropriate can reduce costs while providing comparable cure rate and cosmesis.ObjectiveTo identify characteristics associated with exclusive (outlier) performance of excision or destruction for NMSC.MethodsThe study consisted of malignant excision and destruction procedures submitted by dermatologists to Medicare in 2019. Proportions of services for each method were analyzed with respect to geographic region, years of dermatology experience, median income of the practice zip code, and rural-urban commuting area (RUCA) code.ResultsFewer years of experience predicted a higher proportion of excisions (R2 = 0.7, p < .001) and higher odds of outlier excision performance. Outlier performance of excision was associated with practicing in the South, Midwest, and West, whereas outlier performance of destruction was associated with practicing in the Northeast and Midwest.ConclusionsDermatologists with less experience or in certain geographic regions performed more malignant excision relative to destruction. As the older population of dermatologists retires, the cost of care for NMSC may increase.

High-Frequency Ultrasound in Diagnosis and Treatment of Non-Melanoma Skin Cancer in the Head and Neck Region

Non-melanoma skin cancer is one of the most frequently diagnosed cancers in the human body and unfortunately the incidence continues to increase. NMSC is represented by the basal cell carcinomas (BCCs) and squamous cell carcinomas (SCCs), which are the most prevalent forms, and basosquamous cell carcinomas (BSC) together with Merkel cell carcinoma (MCC), which are rare types but with a very aggressive pattern and poor prognosis. The pathological diagnosis is hard to assess without a biopsy, even by the dermoscopy. Moreover, the staging can be problematic because there is no access clinically to the thickness of the tumor and the depth of the invasion. The aim of this study was to evaluate the role of ultrasonography (US), which is a very efficient imaging method, non-irradiating and cheap, in diagnosis and treatment of non-melanoma skin cancer in the head and neck region. Thirty-one patients with highly suspicious malignant lesions of the head and neck skin were evaluated in the Oral and Maxillo-facial Surgery Department and Imaging Department in Cluj Napoca, Romania. All tumors were measured with three transducers: 13 MHz, 20 MHz and 40 MHz. Doppler examination and elastography were also used. The length, width, diameter, thickness, the presence of necrosis, status of regional lymph nodes, the presence of hyperechoic spots, strain ratio and vascularization were all recorded. After that, all patients were treated by surgical resection of the tumor and reconstruction of the defect. Immediately after surgical resection, all tumors were measured again after the same protocol. The resection margins were evaluated by all three types of transducers in order to detect malignant involvement and the results were compared with the histopathological report. We found that the 13 MHz transducers offered a big picture of the tumor but the level of details, in the form of the presence of the hyperechoic spots, is reduced. We recommend this transducer for evaluation of surgical margins or for the large skin tumors. The 20 and 40 MHz transducers are better for viewing the particularities of malignant lesions and for an accurate measurement; however, in the case of large size lesions, assessing all three dimensions of the tumor can be difficult. The intralesional hyperechoic spots are present in case of BCC and they can be used for differential diagnosis of BCC.

Classic and new strategies for the treatment of advanced melanoma and non-melanoma skin cancer.

Advanced melanoma and non-melanoma skin cancers (NMSCs) are burdened with a dismal prognosis. To improve the survival of these patients, studies on immunotherapy and target therapies in melanoma and NMSCs are rapidly increasing. BRAF and MEK inhibitors improve clinical outcomes, and anti-PD1 therapy demonstrates better results than chemotherapy or anti-CTLA4 therapy in terms of the survival of patients with advanced melanoma. In recent years, the combination therapy of nivolumab plus ipilimumab has gained ground in studies for its survival and response rate benefits in patients with advanced melanoma. In addition, neoadjuvant treatment for stages III and IV melanoma, either as monotherapy or combination therapy, has recently been discussed. Another promising strategy evaluated in recent studies is the triple combination of anti-PD-1/PD-L1 immunotherapy and anti-BRAF plus anti-MEK targeted therapy. On the contrary, in advanced and metastatic BCC, successful therapeutic strategies, such as vismodegib and sonidegib, are based on the inhibition of aberrant activation of the Hedgehog signaling pathway. In these patients, anti-PD-1 therapy with cemiplimab should be reserved as the second-line therapy in case of disease progression or poor response. In patients with locally advanced or metastatic SCC, who are not candidates for surgery or radiotherapy, anti-PD1 agents such as cemiplimab, pembrolizumab, and cosibelimab (CK-301) have shown significant results in terms of response rate. PD-1/PD-L1 inhibitors, such as avelumab, have also been used in Merkel carcinoma, achieving responses in half of the patients with advanced disease. The latest prospect emerging for MCC is the locoregional approach involving the injection of drugs that can stimulate the immune system. Two of the most promising molecules used in combination with immunotherapy are cavrotolimod (a Toll-like receptor 9 agonist) and a Toll-like receptor 7/8 agonist. Another area of study is cellular immunotherapy with natural killer cells stimulated with an IL-15 analog or CD4/CD8 cells stimulated with tumor neoantigens. Neoadjuvant treatment with cemiplimab in CSCCs and nivolumab in MCCs has shown promising results. Despite the successes of these new drugs, the new challenges ahead will be to select patients who will benefit from these treatments based on biomarkers and parameters of the tumor microenvironment.

Wearable devices for photodynamic therapy – A systematic review

Wearable devices for photodynamic therapy – A systematic review

Analysis of image-guided superficial radiation therapy (IGSRT) on the treatment of early-stage non-melanoma skin cancer (NMSC) in the outpatient dermatology setting

BackgroundInterest in image-guidance superficial radiation therapy (IGSRT) for the treatment of early-stage non-melanoma skin cancer (NMSC) has resurfaced given its low complication rates, superior cosmesis and local control and cure rates. In addition, it has been recommended by the American Academy of Dermatology (AAD) for early-stage NMSC in patients who are considered poor surgical candidates.Methods1899 NMSC lesions were treated with energies ranging from 50 to 100 kilovoltage (kV), for a mean of 20.2 fractions, and treatment dose of 5364.4 centigray (cGy). Lesions were treated for a mean of 7.5 weeks and followed for 65.5 weeks. SAS studio was used to conduct Kaplan–Meier analysis to calculate local control rates and account for differences in follow-up intervals. A log-rank test was used to calculate statistical differences between histologies.ResultsAbsolute lesion control was achieved in 99.7% of the patients after an average of 7.5 weeks of treatment, with a stable control rate of 99.6% when the follow-up duration was over 12 months. 95% of lesions with toxicity scoring received a Radiation Treatment Oncology Group Toxicity (RTOG) score of 1 or 2.ConclusionIGSRT has a high safety profile, can achieve superior cosmesis and should be considered first-line for treating early-stage NMSC tumors as cure rates have been shown to be effective in all NMSC on early follow-up.

Same Day Biopsy and Treatment of Non-Melanoma Skin Cancer in Patients with Field Cancerization: A Retrospective Chart Study.

Patients with field cancerization will develop numerous superficial non-melanoma skin cancers (NMSCs). Treating patients with field cancerization can be challenging and burdensome due to the numerous non-melanoma skin cancers (NMSCs) they develop and the frequent dermatology visits required for biopsy and treatment. The success rate of diagnosing and treating lesions suspicious for NMSCs on the same day is measured, immediately after biopsy. We retrospectively reviewed records of patients with same day lesion diagnosis and curettage treatment to determine diagnostic accuracy, treatment failure, and number needed to treat to reduce a follow-up treatment. A total of 237 lesions underwent same day biopsy and treatment, of which the majority were NMSC (66%) or actinic keratosis (23%). Patients had at least 3 months and a median of 17 months follow-up. A total of 20 lesions either recurred or were deemed to require additional treatment. The number needed to treat (NNT) to prevent one follow-up treatment was 1.3. Limitations: sample size limited ability to determine risk factors for treatment failure. Simultaneous diagnosis and treatment of superficial NMSCs is a successful way of improving efficiency and patient satisfaction.

Limited Access to Dermatology Specialty Care: Barriers and Teledermatology.

Access to dermatology specialty care is limited in the underserved population. Barrier identification and exploring the potential role of teledermatology are the first steps to address this problem. Identify the barriers to dermatologist care for the diagnosis and treatment of melanoma and non-melanoma skin cancers in the underserved population. Additionally explored was the potential role of teledermatology to provide dermatology care access in the underserved population. A quantitative descriptive study was conducted via an online survey instrument. The survey's barriers portion was adapted from the 1998 Ohio Family Health Survey (OFHS). The survey's teledermatology portion was adapted from the McFarland Teledermatology Provider and Imaging Technician Satisfaction Survey. The participants were practicing dermatologists and members of Georgia, Missouri, Oklahoma, and Wisconsin dermatology associations. Thirty-eight responded to demographic questions, of which twenty-two responded to the survey items. The top three barriers ranked as the most concerning were "continually uninsured" (n = 8; 36.40%), "resides in a medically underserved county" (n = 5; 22.70%), and "family under federal poverty level" (n = 7; 33.30%). Teledermatology as a potential role for access to care was supported by convenient delivery of healthcare (n = 6; 72.70%), an addition to regular patient care (n = 20; 90.90%), and increase to patient care access (n = 18; 81.80%). Barrier identification and teledermatology access to provide care to the underserved population is supported. Further teledermatology research is necessary to address the logistics regarding how to initiate and deliver teledermatology to the underserved.

Translated article] RF – Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer

Translated article] RF – Intralesional 5-Fluorouracil in the Treatment of Nonmelanoma Skin Cancer

High resolution dermal ultrasound (US) combined with superficial radiation therapy (SRT) versus non-image guided SRT or external beam radiotherapy (XRT) in early-stage epithelial cancer: a comparison of studies

BackgroundTo compare the effectiveness of high-resolution dermal ultrasound (US) guided superficial radiotherapy (SRT) to non-image-guided radiotherapy in the treatment of early-stage Non-Melanoma Skin Cancer (NMSC).MethodsA high-resolution dermal ultrasound (US) image guided form of superficial radiation therapy (designated here as US-SRT) was developed in 2013 where the tumor configuration and depth can be visualized prior to, during, and subsequent to treatments, using a 22 megahertz (MHz) dermal ultrasound (US) with a doppler component. We previously published the results using this technology to treat 2917 early-stage epithelial cancers showing a high local control (LC) rate of 99.3%. We compared these results with similar American studies from a comprehensive literature search used in an article/guideline published by American Society of Radiation Oncology (ASTRO) on curative radiation treatment of basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and squamous cell carcinoma in-situ (SCCIS) lesions from 1988 to 2018. Only U.S. based studies with greater than 100 cases with similar patient/lesion characteristics and stages treated by external beam, electron, or superficial/orthovoltage radiation therapy were included in the criteria for selection. The resultant 4 studies had appropriate comparable cases identified and the data analyzed/calculated with regard to local control. Logistic regression analysis was performed comparing each study to US-SRT individually and collectively with stratification by histology (BCC, SCC, and SCCIS).ResultsUS-SRT LC was found to be statistically superior to each of the 4 non-image-guided radiation therapy studies individually and collectively (as well as stratified by histology subtype) with p-values ranging from p < 0.0001 to p = 0.0438.ConclusionsResults of US-SRT in local control were statistically significantly superior across the board versus non-image-guided radiation modalities in treatment of epithelial NMSC and should be considered a new gold standard for treatment of early-stage cutaneous BCC, SCC, and SCCIS.

Advances in Photodynamic Therapy for the Treatment of Actinic Keratosis and Nonmelanoma Skin Cancer: A Narrative Review.

Photodynamic therapy (PDT) with photosensitization using 5-aminolevulinic acid (ALA) [including a nanoemulsion (BF-200 ALA)] is approved in the USA for the treatment of actinic keratoses (AKs); another derivative, methyl aminolevulinate, is not approved in the USA but is used in Europe. For AK treatment, the photosensitizer may be applied to individual AK lesions or, depending on treatment regimen, to broader areas of sun-damaged skin to manage field cancerization, although not all products are approved for field treatment. ALA-PDT and photosensitizers have also been used off-label for the treatment of nonmelanoma skin cancers, primarily basal cell carcinomas (BCCs) and cutaneous squamous cell carcinomas (cSCC). Advantages of PDT include potentially improved cosmesis and patient satisfaction; disadvantages include pain and duration of treatment. Alternative illumination approaches, including intense pulsed light as well as pulsed-dye lasers, have also been used successfully. Pretreating the affected tissue or warming during incubation can help to increase photosensitizer absorption and improve therapeutic efficacy. Combinations of multiple treatments are also under exploration. Reducing incubation time between photosensitizer application and illumination may significantly reduce pain scores without affecting treatment efficacy. Substituting daylight PDT for a conventional illumination source can also reduce pain without compromising efficacy. The objective of this narrative review is to describe current and ongoing research in the use of topical photosensitizers and modified light delivery regimens to achieve improved therapeutic outcomes with less toxicity in patients with AK, cSCC, BCC, and field cancerization.

Monoolein-based nanodispersions for cutaneous co-delivery of methylene blue and metformin: Thermal and structural characterization and effects on the cutaneous barrier, skin penetration and cytotoxicity

This study evaluated the potential of monoolein (MO)-based nanodispersions to promote the cutaneous co-delivery of metformin (MET) and methylene blue (MB) for the treatment of non-melanoma skin cancer. MO-based nanodispersions were obtained using Kolliphor® P407 (KP) and/or sodium cholate (CH), and characterized concerning the structure, thermal stability, ability to disrupt the skin barrier, cutaneous permeation and retention of MB and MET. Additionally, the cytotoxic effect of MO nanodispersions-mediated combination therapy using MET and MB in A431 cells was evaluated. The nanodispersions exhibited nanometric size (<200 nm) and thermal and physical stability. Small angle X-ray scattering studies revealed multiple structures depending on composition. They were able to interact with stratum corneum lipid structure, increasing its fluidity. The effect of MO-nanodispersions on topical/transdermal delivery of MB and MET was composition-dependent. Nanodispersions with low MO content (5 %) and stabilized with KP and CH (0.05–0.10 %) were the most promising, enhancing the cutaneous delivery of MB and MET by 1.9 to 2.2-fold and 1.4 to 1.7-fold, respectively, compared to control. Cytotoxic studies revealed that the most promising MO nanodispersion-mediated combination therapy using MET and MB (1:1) reduced the IC50 by 24-fold, compared to MB solution, and a further reduction (1.5-fold) was observed by MB photoactivation.

Formulation and development of novel lipid-based combinatorial advanced nanoformulation for effective treatment of non-melanoma skin cancer

Non-melanoma skin cancer is one of the most common malignancies reported with high number of morbidities, demanding an advanced treatment option with superior chemotherapeutic effects. Due to high degree of drug resistance, conventional therapy fails to meet the desired therapeutic efficacy. To break the bottleneck, nanoparticles have been used as next generation vehicles that facilitate the efficient interaction with the cancer cells. Here, we developed combined therapy of 5-fluorouracil (5-FU) and cannabidiol (CBD)-loaded nanostructured lipid carrier gel (FU-CBD-NLCs gel). The NLCs were optimized using central composite design that showed an average particle size of 206 nm and a zeta potential of −34 mV. In addition, in vitro and ex vivo drug permeations studies demonstrated the effective delivery of both drugs in the skin layers via lipid structured nanocarriers. Also, the prepared FU-CBD-NLCs showed promising effect in-vitro cell studies including MTT assays, wound healing and cell cycle as compared to the conventional formulation. Moreover, dermatokinetic studies shows there was superior deposition of drugs at epidermal and the dermal layer when treated with FU-CBD-NLCs. In the end, overall study offered a novel combinatorial chemotherapy that could be an option for the treatment of non-melanoma skin cancer.

Long-term clinical outcomes of non-melanoma skin cancer patients treated with electronic brachytherapy.

High-dose-rate electronic brachytherapy (eBx) is a non-surgical treatment option for non-melanoma skin cancer (NMSC) patients. This study assessed long-term effectiveness and safety of eBx for the treatment of NMSC. A chart review was conducted to identify subjects who had five or more years since their last eBx treatment fraction. Subjects meeting these criteria were contacted to determine their interest in participating in a long-term follow-up study. Those who agreed, underwent a follow-up visit where consent was obtained, and their lesions were clinically assessed for recurrence and long-term skin toxicities. History and demographic data were retrospectively collected, and treatment method was verified. 183 subjects with 185 lesions were enrolled into this study at four dermatology centers in two practices in California. Three subjects in the analysis were less than 5 years from the last treatment to follow-up visit. All lesions were stage 1 basal cell carcinoma, squamous cell carcinoma, or squamous cell carcinoma in situ. Recurrence rate for the 183 subjects was 1.1%. Long-term skin toxicities were reported in 70.0% of the subjects. Hypopigmentation grade 1 was observed in 65.9% of the lesions, telangiectasia grade 1 was seen in 22.2%, scarring grade 1 in two subjects (1.1%), hyperpigmentation grade 1 in two subjects (1.1%), and induration grade 2 in one patient (0.5%). The induration grade 2 was located on the upper back and did not limit instrumental activities of daily living (ADLs). Electronic brachytherapy for the treatment of non-melanoma skin cancer is safe and effective, showing excellent long-term 98.9% local control through a median follow-up of 7.6 years (n = 183), with minimal long-term toxicities.

Treatment results with 5-mm surgical excision in nonmelanoma skin cancers: Analysis of 234 cases

Background: Basal cell carcinoma and squamous cell carcinoma constitute the majority of nonmelanoma skin cancers. In our study, we analyzed our results of nonmelanoma skin cancer treatment with 5-mm surgical excision and compared them with the literature. Material and Methods: Patients treated at Ankara City Hospital Plastic, Reconstructive, and Aesthetic Surgery Clinic between February 2019 and March 2022 were included in this study. Demographic data, anatomical region, tumor subtype/differentiation, surgical margins, reconstruction method, and recurrence parameters were recorded. IBM SPSS Statistics (version 26.0) was used for the data analysis. Results: Of the 234 cases, 163 were reported as basal cell and 71 as squamous cell cancer. Margin positivity with 5-mm surgical excision was 14.1% and 16.9% in basal and squamous cell cancer, respectively. Nineth-month recurrence rates were 4.2% and 19.7% in basal and squamous cell cancer, respectively. Conclusions: All surgical margin positivity and recurrences were located in the head and neck regions, revealing the importance of developing treatment references according to the anatomical region.

Insurance Coverage of Dermabrasion and Chemical Peel Procedures: A Critical Analysis of 58 American Insurance Companies.

Introduction Dermabrasion and chemical peels are infrequently utilized methods of treatment for medical-grade conditions despite demonstrations of favorable outcomes. Insurance coverage status has previously been shown to impact availability and accessibility to specific treatments. The purpose of this study is to evaluate the rate of insurance coverage provided for dermabrasionand chemical peel procedures in the treatment of acne, acne scarring,and non-melanoma skin cancers (NMSC). Methods A cross-sectional analysis of 58 insurance companies by web-basedsearch or phone interview determined the number of insurers with a publicly available policy on dermabrasion or chemical peels. Coverage status and any corresponding criteria were extracted from existing company policies. Results Thirteen (22%) and 22 (38%) policies discussed dermabrasion in the treatment of basal cell carcinoma and actinic keratosis, with 62% and 73% of these policies providing coverage. Acne scarring was discussedin significantly more dermabrasion policies than basal cell carcinoma (45% vs 22%; p=0.018). However, significantly more insurers denied coverage of dermabrasion for active acne and acne scarring when compared to dermabrasionto treat basal cell carcinoma or actinic keratosis (p<0.001).Eighty-seven percent of companies (n=20) with a chemical peel policy for premalignant lesions would providecoverage, with required criteria present in 95% (n=19) of thepolicies that would coverchemical peels for actinic keratosis specifically. Of the 25 companies (43%) that discussed the treatment of acne with chemical peel procedures, 14 (56%) provided coverage, and 11 (44%) denied coverage. Coveragewas denied by significantly less insurersfor the treatment of active acne with chemical peel procedures compared to treatment with dermabrasion(44% vs 83%; p<0.006). Conclusion Significant discrepancies were noted in both the presence of a publicpolicy and the coverage status of dermabrasion or chemical peel proceduresamong the United States health insurance companies. These inconsistencies, along with multiple criteria required for coverage, may create an artificial barrier to receiving care for specific medical-grade conditions.

74. See and Treat for non-melanoma skin cancers in an OMFS unit: A successful change of practice and service improvement as a result of the COVID-19 pandemic

During the COVID-19 pandemic, our unit converted to a see and treat model for the treatment of non-melanoma skin cancers (NMSCs), aiming to undertake complete excision at the first review. The intention was to reduce patient contact, to reduce the risk of virus transmission, whilst keeping waiting times to a minimum. This audit aimed to assess whether “See and treat” is an effective strategy and to determine whether it should continue following easing of lockdown restrictions.