FAQ : Skin cancer

Skin cancers are characterized by an uncontrolled and abnormal multiplication of skin tissue (skin tissue). There are two main categories:

• carcinomas (about 90% of cases)
• melanomas (about 10% of cases)

Other types of skin cancers also exist, such as Merkel cell carcinoma, Kaposi sarcoma, and cutaneous lymphoma, but they are much less common, accounting for less than 1% of skin cancers.

Skin melanomas are cancerous tumours that form from skin cells called melanocytes that make melanin, a pigment that colours the skin.

Cutaneous melanomas can develop on any part of the body, but they often develop on parts of the skin that are exposed to the sun, such as the face, neck, arms, and legs. However, it can also develop on parts of the body that are not exposed to sunlight, such as mucous membranes, the soles of the feet, or the palms of the hands.

For more information, you can consult the site of Cancer and skin.

Mucosal melanoma is a form of melanoma that develops on mucous membranes, such as those in the mouth or vulva.

Uveal melanoma, also called ocular melanoma, is a rare form of melanoma that develops from melanocytes in the eye.

Although relatively rare, uveal melanomas are the most common type of eye cancer in adults.

Histology is the set of characteristics of cancerous tissue, determined microscopically by anatomopathological examination.

This information can be found on the pathologic report or on a consultation report.

It is essential to indicate histology among the proposed list as some may allow access to clinical trials and targeted drugs.

There are several histological subtypes:

• Extensive superficial melanoma (= with superficial spread SSM): the most common form of melanoma.
• Lentigo Malignant Melanoma
• Dubreuilh melanoma
• Nodular melanoma
• Acrolentiginous melanoma (acral lentiginous)

A biomarker, also called in some cases a genetic mutation, is a measurable biological characteristic linked to a normal or non-normal process.

In oncology, among biomarkers, certain abnormalities (often mutations) at the level of a gene can predict the action of a targeted drug.

This information can be found on the Molecular Biology Report (or NGS) or a consultation report.

It is essential to inform these genetic biomarkers/mutations when researching clinical trials on Klineo, because it can pave the way for clinical trials using targeted drugs specific to these alterations.

Example in dermatology: BRAF, c-Kit, NRAS...

A BRAF V600E or V600K melanoma is a melanoma that is characterized by a specific mutation in the BRAF gene, called a V600 mutation. This mutation is sought by various techniques such as immunohistochemistry (IHC) or NGS sequencing. This information can be found on the pathologic report or on a consultation report. This mutation in the BRAF gene occurs in about half of melanomas, especially the BRAF V600E or BRAF V600K mutation. Melanomas with the BRAF V600 mutation tend to be more aggressive and more invasive than melanomas without this mutation. However, melanomas with the BRAF V600 mutation can be treated with specific targeted therapies that aim to block the activity of the mutated BRAF protein.

Knowing the mutational status of BRAF is essential when researching clinical trials on Klineo, because it can pave the way for clinical trials using targeted drugsspecific to the BRAF mutation.

Melanoma can also have other genetic mutations (also called biomarkers).

It is essential to indicate them if this is the case because some may allow access to clinical trials and targeted drugs specific to these alterations. This information can be found on the Molecular Biology Report (or NGS) or a consultation report.

It is essential to inform these genetic biomarkers/mutations when researching clinical trials on Klineo, because it can pave the way for clinical trials using targeted drugs

In melanoma, we look in particular for:

• C-kit

• ARMS

• ALK

• ROS1

• NF1

• TP53...

(complete list on the Klineo platform)

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

In melanoma, we look in particular for:

• The T, which describes the size and extent of the tumor
• The N, which indicates whether the cancer has spread to nearby lymph nodes
• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

The Breslow Index is a measure of tumor thickness that is used to assess the severity of melanoma. The Breslow Index is an important element in the classification of melanoma according to the TNM classification system. More specifically, it is used to determine category T, which measures the size and extension of the tumor.

This information can be found on the pathologic report or a consultation report.

NB: On the platform Klineo, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

TNM classification table for melanomas

Primary tumour (T)

Lymph nodes (N)

Distant metastases (M)

The stage of melanoma is based on a correspondence to the TNM score (see above), which is a system used to describe the extent of cancer spread. In melanoma, there are 5 different stages (0 to IV). The correspondence table below summarizes the different stages according to the TNM score.

Melanoma clinical staging chart

Chemotherapy is a treatment that uses powerful drugs to destroy cancer cells by stopping them from multiplying or spreading in the body. Chemotherapy medications can be given intravenously (into a vein), orally (as tablets or capsules), or by subcutaneous injection (under the skin).

Chemotherapy may be used alone or in combination with other treatments such as surgery or radiation therapy, depending on the type and stage of the cancer, as well as the patient’s overall health. While chemotherapy can be very effective in destroying cancer cells, it can also damage healthy cells, leading to side effects such as hair loss, fatigue, nausea and vomiting, and suppression of the immune system.

In the context of cutaneous melanoma, the chemotherapies that are often used are:

• Dacarbazine (Deticene)
• Fotemustine (Muphoran)

Radiation therapy consists in using radiation (also called rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers.

Immunotherapy is a type of treatment that aims to stimulate the body’s immune defenses against cancer cells. Its effectiveness has been demonstrated in a large number of cancers, even if its tolerance is marked by a specific toxicity profile linked to the reactivation of the immune system.

As part of the cutaneous melanoma, the targeted therapies that are often used are:

• Monoclonal antibodies:
  • Anti PD1 Antibodies: Pembrolizumab (Keytruda), Nivolumab (Opdivo)
  • Anti CTLA4 Antibody: Ipillilumbab (Yervoy)
• Cytokines:
  • Interferon alfa-2b (Intron A)
  • Interleukin-2 (aldesleukin, Proleukin)

Targeted therapy is a drug treatment that specifically targets genetic or molecular abnormalities or alterations present in cancer cells. Unlike conventional treatments such as chemotherapy that act on all cells in the body, targeted therapies work more selectively, by blocking or inhibiting specific proteins involved in the growth and proliferation of cancer cells. Targeted therapies are often used in combination with other treatments such as chemotherapy or radiation therapy. They are being used more and more in the treatment of cancer.

In the context of cutaneous melanoma, the targeted therapies that are often used are:

• If BRAF mutated:
  • Vemurafenib (ZELBORAF)
  • Dabrafenib (TAFINLAR)
  • Trametinib (MEKINIST)
  • Encorafenib (BRAFTOVI)
  • Cobimetinib (COTELLIC)
  • Binimetinib (MEKTOVI)...

• If c-Kit mutated:
  • Imatinib (GILVEC)

Cutaneous basal cell carcinoma (CBC) develops from cells in the deepest layer of the epidermis, i.e. keratinocytes in the basal layer.

This type of skin cancer is the most common, accounting for approximately 70% of skin cancer cases. Although basal cell carcinoma can cause local damage, it is considered to be of low danger because it rarely has the ability to metastasize (that is, it is unlikely to give rise to secondary tumors in other parts of the body).

For more information, you can consult the site of Cancer and skin.

There are four main histological subtypes:

• Nodular or called “pearlescent pearl”: it is the most common form characterized by a lesion that is firm to the touch presenting a vascularization.
• Superficial: carcinoma is characterized by the presence of a scaly and desquamating skin plaque.
• Sclerodermiform: Carcinoma takes the form of a hardened scar patch that may be lighter than normal skin.
• Infiltrative

Other histological subtypes are also individualized:

• Metatypic
• Micronodular
• Fibroepithelial (Pinkus tumor)
• Keratinizing
• Mixed or composite carcinoma

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Other histological subtypes are also individualized:

• The T, which describes the size and extent of the tumor
• The N, which indicates whether the cancer has spread to nearby lymph nodes
• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

TNM classification table for cutaneous basal cell carcinoma

Primary tumour (T)

Lymph nodes (N)

Distant metastases (M)

The stage of melanoma is based on a correspondence to the TNM score (see above), which is a system used to describe the extent of cancer spread. In melanoma, there are 5 different stages (0 to IV). The correspondence table below summarizes the different stages according to the TNM score.

At the localized stage: The first line of treatment is surgical. Other treatments can also be used (chemotherapy, radiology, etc.).

At the locally advanced/metastatic stage: treatments include surgery, radiation, immunotherapy, and chemotherapy.

Basal cell carcinoma rarely has the ability to metastasize (that is, it is unlikely to give rise to secondary tumors in other parts of the body).

Surgery : Surgery is the main treatment for basal cell carcinomas. Different surgical techniques can be used depending on size, location and medical history (surgical excision, Mohs surgery, curettage, cryosurgery, Curetage-Electrocoagulation...).

Local treatments : Local treatments are possible. Among these treatments:

• Dynamic phototherapy: A cream containing a photosensitive substance, which is particularly well absorbed by cancer cells, is applied to the tumor. It is then exposed to a high-intensity light source, causing the destruction of cancer cells. This treatment can be combined with the application of a cream:imiquimod (ALDARA, ZYCLARA).
• Chemotherapy local in the form of a cream. Example: 5-Fluoro-Uracil (5-FU).

Radiotherapy : Radiotherapy consists in using radiation (we also say rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers. In the case of cutaneous basal cell carcinomas, radiation therapy is offered as the first line treatment when surgery is not possible. Radiation therapy may also be prescribed after surgery, this is called adjuvant therapy.

Chemotherapy : This is a treatment that uses powerful drugs to destroy cancer cells by preventing them from multiplying or spreading in the body. In the case of cutaneous basal cell carcinomas, chemotherapy may be offered in the form of:

• Local chemotherapy in the form of a cream. Example: 5-Fluoro-Uracil (5-FU).
• Intravenous chemotherapy if basal cell carcinoma has invaded neighboring areas or if it has spread. Example: Cisplatin (PLATINOL AQ) alone or combined with Paclitaxel (TAXOL).

Targeted treatment : Targeted therapy is a drug treatment that specifically targets genetic or molecular abnormalities or alterations present in cancer cells or other diseased cells.

Immunotherapy :: Immunotherapy is a treatment that aims to stimulate the body’s immune defenses against cancer cells. In the case of cutaneous basal cell carcinomas, the immunotherapy that is often used is Cemiplimab (LIBTAYO).

There are other treatments available via clinical trials. Thanks to Klineo, you can find the clinical trials that are right for you. To do this, it is important to enter the treatments received in order to find relevant clinical trials. This information can be found in the recent consultation report.

Cutaneous squamous cell carcinoma (CEC), also called squamous cell carcinoma, develops from keratinocytes in the middle layer of the epidermis. It accounts for about 20% of skin cancer cases. Unlike basal cell carcinoma, the prognosis for squamous cell carcinomas is less favorable because it has a greater ability to invade surrounding tissue and metastasize (i.e. spread to other parts of the body). Early detection and treatment of squamous cell carcinomas is important to improve the chances of recovery and to avoid potential complications.

There are several histological subtypes of squamous cell carcinoma, among them:

• Common carcinoma
• Acantholytic carcinoma
• Spindle cell carcinoma
• Verrucous carcinoma
• Pseudovascular carcinoma
• Metatypic and mixed carcinomas
• Fusiform cell carcinoma in a non-irradiated zone.
• Adenosquamous carcinoma
• Muco-squamous cell carcinoma
• Desmoplastic carcinoma

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

There are several histological subtypes of squamous cell carcinoma, among them:

• The T, which describes the size and extent of the tumor
• The N, which indicates whether the cancer has spread to nearby lymph nodes
• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

(see table below)

This information can be found on the pathologic report or a consultation report.

NB: On the Klineo platform, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

TNM classification table for cutaneous squamous cell carcinoma

Primary tumour (T)

Regional lymph nodes (N)

Distant metastases (M)

The stage of the cancer is based on a correspondence to the TNM score (see above), which is a system used to describe the extent of cancer spread. In the context of squamous cell carcinoma, there are 5 different stages (0 to IV). The correspondence table below summarizes the different stages according to the TNM score.

Clinical staging table for squamous cell carcinoma

It is essential to indicate the stage in order to access clinical trials and targeted drugs. This information can be found on the pathologic report or a consultation report.

At the localized stadium : the first-line treatment is surgical. Other treatments can also be used (chemotherapy, radiology, etc.).

In the locally advanced/metastatic stage : treatments include surgery, radiation therapy, immunotherapy, and chemotherapy.

Surgery: Surgery is the main treatment for cutaneous squamous cell carcinomas (CEC). Different surgical techniques can be used depending on size, location and medical history (surgical excision, Mohs surgery, curettage, cryosurgery, Curetage-Electrocoagulation...).

Local treatments : Local treatments are possible. Among these treatments:

• Dynamic phototherapy : A cream containing a photosensitive substance, which is particularly well absorbed by cancer cells, is applied to the tumor. It is then exposed to a high-intensity light source, causing the destruction of cancer cells.
• Topical cream : imiquimod (ALDARA, ZYCLARA).

Radiotherapy : Radiotherapy consists in using radiation (we also say rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers. In the case of cutaneous squamous cell carcinomas, radiation therapy is offered as the first line treatment when surgery is not possible. Radiation therapy may also be prescribed after surgery, this is called adjuvant therapy.

Chemotherapy : This is a treatment that uses powerful drugs to destroy cancer cells by preventing them from multiplying or spreading in the body. In the case of cutaneous squamous cell carcinomas, chemotherapy may be offered in the form of:

• Local chemotherapy in the form of a cream. Example: 5-Fluoro-Uracil (5-FU, Efudex).
• Intravenous chemotherapy if squamous cell carcinoma has invaded neighboring areas or if it has spread. Example: Cisplatin (PLATINOL AQ) alone or in combination with other medications, such as interferon alpha (Intron A, Wellferon) and retinoids.

Immunotherapy : Immunotherapy is a treatment that aims to stimulate the body’s immune defenses against cancer cells. In the case of cutaneous squamous cell carcinomas, the immunotherapies that are often used are:

• Anti-PD1 antibodies: Cemiplimab (LIBTAYO) and Pembrolizumab (KEYTRUDA)
• Anti-VEGF antibodies: Cetuximab (ERBITUX)

There are other treatments available via clinical trials. With Klineo, you can find the clinical trials that suit your situation. For this, it is important to enter the treatments received in order to find relevant clinical trials. This information can be found in the recent consultation report.

Merkel carcinoma, also called cutaneous neuroendocrine carcinoma, is a rare and aggressive type of skin cancer. It develops from Merkel cells, cells responsible for the sensation of touch in the epidermis (surface layer of the skin).

For more information, you can consult the site of Cancer and skin.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

There are several histological subtypes of squamous cell carcinoma, among them:

• The T, which describes the size and extent of the tumor
• The N, which indicates whether the cancer has spread to nearby lymph nodes
• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

(see table below)

This information can be found on the pathologic report or a consultation report.

NB: On the Klineo platform, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

TNM classification table for Merkel carcinoma

Primary tumour (T)

Lymph nodes (N)

Distant metastases (M)

The stage of melanoma is based on a correspondence to the TNM score (see above), which is a system used to describe the extent of cancer spread. In the context of Merkel carcinoma, there are 5 different stages (0 to IV). The correspondence table below summarizes the different stages according to the TNM score.

Clinical staging chart for Merkel carcinoma

At the localized stadium : surgery is the main treatment, followed by radiation therapy. Adjuvant chemotherapy may be combined with surgery and radiation therapy.

In the metastatic stage : Immunotherapy treatment may be proposed (anti-PDL1). The alternative to this treatment may be chemotherapy with carboplatin-etoposide.

Surgery : Surgery is the main treatment for Merkel carcinomas. Different surgical techniques can be used depending on size, location and medical history (surgical excision, Mohs surgery, lymph node dissection...)

Radiotherapy : Radiotherapy consists in using radiation (we also say rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers. In the case of Merkel carcinomas, radiation therapy may also be prescribed after surgery, this is called adjuvant therapy.

Chemotherapy : This is a treatment that uses powerful drugs to destroy cancer cells by preventing them from multiplying or spreading in the body. In the case of Merkel carcinomas, the most common chemotherapies are:

• Cisplatin (Platinol AQ) or carboplatin (Paraplatin, Paraplatin AQ), which can be combined with etoposide (Vepesid, VP-16). Only topotecan (Hycamtin) may be used in some cases.

Immunotherapy: Immunotherapy is a treatment that aims to stimulate the body’s immune defenses against cancer cells. In the case of Merkel carcinomas, anti-PDL1 antibodies, such as Avelumab (BAVENCIO), may be used in some cases.

There are other treatments available via clinical trials. With Klineo, you can find the clinical trials that suit your situation. For this, it is important to enter the treatments received in order to find relevant clinical trials. This information can be found in the recent consultation report.

Skin lymphoma is a cancer of the lymphatic system that affects the skin.

The lymphatic system is responsible for producing immune cells, which help protect the body from infection and disease. Cutaneous lymphomas are rare. There are various types of cutaneous lymphomas, but the two most common types are cutaneous T-cell lymphoma and cutaneous large cell lymphoma.

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

There are several histological subtypes of squamous cell carcinoma, among them:

• The T, which describes the size and extent of the tumor

• N, which indicates if cancer has spread to nearby lymph nodes

• The M, which indicates whether the cancer has spread to other parts of the body, called metastases

(see table below)

It should be noted that, in the case of cutaneous T-cell lymphomas, the count of circulating B cells in the peripheral blood is also considered in the TNM classification.

This information can be found on the pathologic report or a consultation report.

NB: On the Klineo platform, it is a simplified version of the TNM stadium. In the search fields, only the first number following the letter must be selected (ex: “Pt1c N0i+ M0” = “T1N0M0”)

TNM classification table for cutaneous T-cell lymphoma

Primary tumour (T)

Lymph nodes (N)

Distant metastases (M)

Blood (B)

The TNM score is a classification system used to assess the stage of a cancer, plan treatment, and predict prognosis.

Three parameters must be taken into account:

• The T describes the size and extent of the primary tumor
• The N indicates whether the cancer faces a regional lymph node extension
• The M indicates whether the cancer has spread to other parts of the body, called metastases

In the context of cutaneous T-cell lymphoma, there are 5 different stages (0 to IV). The correspondence table below summarizes the different stages according to the TNM score.

Clinical staging chart for cutaneous T-cell lymphoma

At the localized stadium : these are essentially surgery, local treatments administered directly to the lesions caused by lymphoma as well as phototherapy by rays.

In the metastatic stage : Systemic treatment with chemotherapy or immunotherapy may be proposed.

Surgery : Surgery is recommended in some cases of cutaneous lymphomas.

Local treatments : Local treatments are possible. Among these treatments:

• Dynamic phototherapy : A cream containing a photosensitive substance, which is particularly well absorbed by cancer cells, is applied to the tumor. It is then exposed to a high-intensity light source, causing the destruction of cancer cells.
• Topical creams These are medications to be applied to the skin, such as corticosteroids and chemotherapy that are given in cream form.

Radiotherapy : consists in using radiation (we also say rays or radiation) to destroy cancer cells by blocking their ability to multiply. We are talking about a locoregional treatment of cancers.

Chemotherapy : This is a treatment that uses powerful drugs to destroy cancer cells by preventing them from multiplying or spreading in the body. In the case of cutaneous lymphomas, chemotherapy may be offered in the form of:

• Local chemotherapy in the form of a cream.
• Intravenous chemotherapy if basal cell carcinoma has invaded neighboring areas or has spread.

Targeted treatment : Targeted therapy is a drug treatment that specifically targets genetic or molecular abnormalities or alterations present in cancer cells or other diseased cells.

Immunotherapy : Immunotherapy is a treatment that aims to stimulate the body’s immune defenses against cancer cells. In the case of cutaneous lymphoma, anti-CD20 antibodies, such as MABTHERA (rituximab), may be used in some cases

There are other treatments available via clinical trials. With Klineo, you can find the clinical trials that are right for you. To do this, it is important to enter the treatments received in order to find relevant clinical trials. This information can be found in the recent consultation report.