Hensin Tsao, MD, PhD

How in this day and age is the message of UV protective sunscreen still not clear? Why are we seeing so many BCC’s and SCC’s? All sun-exposed skin contains a large number of driver mutations for skin cancer. The number of persons with at least 1 procedure for NMSC increased by 14% (from 1,177,618 to 1,336,800) from 2006 through 2012 and this may be due in large part to failure to use sunscreen by >80% of men and >50% of women. Our strategies for patient education with regard to the importance of sunscreens and sun avoidance need a continued and renewed voice. Consider educating general practitioners in your area on skin cancer screening and prevention measures. It can save lives.

When sun damage and other factors yield the worst results, combination therapy with new agents targeting immune function have increased survival in patients with melanoma. The result of that is a rise to a growing population of cancer survivors that will require close monitoring. Recent studies, though small in design suggest vitamin B3 supplementation may aid in chemoprevention in high-risk patients. You might consider adding B3 (a more benign option) to a regimen of potentially chemo-preventive agents such as nicotinamide, oral retinoids, topical DNA repair enzymes, and oral NSAIDs.

Finally, it appears that the microbiome is the key to tumor immunity. Studies indicate that gut flora/tumor interaction may extend to therapeutic response. You may want to consider a broader treatment regimen which includes the ingestion of probiotics along with checkpoint inhibitors.