Changes in skin cancer management : a personal perspective.

Even though changes in practice trends for skin cancer therapy are slow, new developments continue, some driven by technology and some driven by socioeconomic factors. Clearly, traditional surgical removal will remain the predominant mode of tumor therapy for the foreseeable future. There will probably be a continued trend of more excision and less ED&C treatment as well as less use of radiation therapy. Medical therapy will likely continue to be used as a surgical alternative, driven by patient demand more than physician choice, but it is doubtful that medical therapy will ever rival surgical technique in terms of numbers in the foreseeable future. Combination therapy with traditional surgery and adjuvant use of medical treatments, such as imiquimod, will likely expand significantly, since it does not threaten any economic considerations and is simply an improvement in outcome over surgery alone. I feel, as dermatologists, we can look forward to being more involved in the treatment of skin cancer than ever before and to newer drugs and methods of treatment as well as combination therapy, which will give us an even greater ability to tailor treatment to individual patients to achieve the desired outcome. All of this will make it difficult for us to be replaced by generalists, which is a good thing, both for us and for our patients.