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Skin Cancer

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Prevention of skin cancer

Last reviewed: October 4, 2026

Introduction

Skin cancer is the most common cancer in the United States. An estimated 5.4 million basal cell and squamous cell skin cancers were treated in 2012 alone, in about 3.3 million people [1]. The head and neck receive more sun than any other part of the body, so a large share of skin cancers arise on the face, scalp, ears, lips and neck. In these areas, treatment has two goals that must be balanced: removing the cancer completely and preserving the appearance and function of the face.

This page covers prevention, the main types of skin cancer (basal cell carcinoma, squamous cell carcinoma, melanoma and Merkel cell carcinoma), how each is diagnosed and treated, and how the skin is repaired after a cancer is removed. A short summary and a numbered reference list are at the end. Where the evidence is limited or mixed, the page says so. Related pages include skin cancer conditions, skin cancer treatments, and lymph nodes and lymphatics.

Protecting your skin

• Link to the American Cancer Society site for excellent information on protecting your skin from harmful ultraviolet rays.

• Link to “How Can I Lower My Risk for Skin Cancer?” on ENTHealth.org.

• The Environmental Working Group’s guide to sunscreens provides excellent information on many of the current sunscreens on the market, including their safety and truth in advertising.

Ultraviolet (UV) light from the sun and from tanning beds is the main avoidable cause of skin cancer. Practical protection includes shade during the middle of the day, a hat with a brim that covers the ears, clothing, and a broad-spectrum sunscreen applied to exposed skin every day, not only on beach days. A daily skin care approach that includes sun protection is described on the skin regimen page.

Sunscreen. The best evidence comes from a randomized trial of 1,621 adults in Nambour, Australia. People assigned to apply sunscreen to the head, neck, arms and hands every day for about 4.5 years developed about 40% fewer squamous cell carcinomas than those who used sunscreen at their own discretion; there was no clear effect on basal cell carcinoma over that time [2]. Ten years after the trial ended, the daily sunscreen group had half as many new melanomas, and about one quarter as many invasive melanomas [3]. These are the results of one trial, but they are consistent and they support daily use. Here is a science based guide for sunscreen options.

Tanning beds. A meta-analysis of 27 studies found that ever using a tanning bed raised the risk of melanoma by about 20%, and starting before age 35 raised it by about 87% [4]. Each additional session per year added risk. There is no safe level of tanning bed use.

Nicotinamide. For people who have already had several skin cancers, nicotinamide (a form of vitamin B3, 500 mg twice daily) lowered the rate of new basal cell and squamous cell carcinomas by 23% over one year in a randomized trial of 386 patients [5]. The benefit stopped when the pills were stopped. A later trial in 158 organ transplant recipients found no benefit, although it closed early [6]. The evidence is therefore mixed. Nicotinamide is a reasonable option to discuss for people at high risk; it is not a substitute for sun protection.

Screening. In 2023, the U.S. Preventive Services Task Force concluded that the evidence is insufficient to recommend for or against routine skin examination by a clinician for adults with no symptoms [7]. This statement concerns screening of the general population. It does not apply to people with a new or changing spot, a history of skin cancer, many moles, or a weakened immune system, who benefit from regular examinations. Guidance on checking your own skin is on the melanoma self-screening page.

Types of skin cancer

The most common type of skin cancer is also the least dangerous: basal cell carcinoma. This is followed in incidence by squamous cell carcinoma.

Here is a link to a great site by the American Cancer Society with lots of information, videos, and photos for various types of skin cancer.

Skin cancers are named for the cell they start from. Basal cell and squamous cell carcinomas start in keratinocytes, the cells that make up most of the outer layer of skin, and are grouped together as keratinocyte carcinomas (also called nonmelanoma skin cancers). In the U.S. Medicare population, basal cell and squamous cell carcinomas are now treated at roughly equal rates [1]. The four types covered on this page differ greatly in how they behave:

  • Basal cell carcinoma: the most common; grows slowly and invades locally, but very rarely spreads.

  • Squamous cell carcinoma: second most common; usually cured with surgery, but a small fraction spread to lymph nodes, particularly around the ear and in the parotid gland.

  • Melanoma: less common, but responsible for most skin cancer deaths; risk depends mainly on the thickness of the tumor.

  • Merkel cell carcinoma: rare and aggressive; often spreads to lymph nodes early.

Any of these is diagnosed with a skin biopsy, in which a small sample is examined under the microscope. The biopsy result, along with the size and location of the tumor, determines the treatment.

squamous cell carcinoma of the skin

Squamous-cell skin cancer, also known as cutaneous squamous-cell carcinoma (cSCC), is one of the most common types of skin cancer along with basal cell cancer, and melanoma. It usually presents as a hard lump with a scaly top but can also form an ulcer. Onset is often over months. Squamous-cell skin cancer is not very likely to spread to distant anatomic sites except when large or aggressive. When confined to the outermost layer of the skin, a precancerous or in situ form of cSCC is known as Bowen's disease.

The greatest risk factor is high total exposure to ultraviolet radiation, which is often from the Sun or tanning beds. Other risks include prior scars, chronic wounds, actinic keratosis, lighter skin, Bowen's disease, arsenic exposure, radiation therapy, poor immune system function, previous basal cell carcinoma, and HPV infection. Risk from UV radiation is related to total (cumulative) exposure, rather than early exposure. It begins from squamous cells found within the skin. Diagnosis is often based on skin examination and confirmed by tissue biopsy. Imaging studies (e.g., a CT scan) are used in cases where extensive disease is suspected. Cancer staging is a way of approximating risk, and ranges from lowest risk (stage I) to greatest risk (stage IV). Treatment is usually with surgical removal, but may also be accomplished with radiation therapy. In advanced cancers, multiple modalities of treatment are often employed to attain better cure rates, and this may include surgery, radiation, chemotherapy, and/or immunotherapy in various orders and sometimes concurrently (such as radiation and chemotherapy simultaneously).

A weakened immune system. People who take medicines that suppress the immune system, such as organ transplant recipients, develop squamous cell carcinoma far more often than the general population, on the order of 65 to 250 times as often, and their cancers tend to be more numerous and more aggressive [8]. Regular skin examinations are especially important for them.

Which cancers are high risk. Most squamous cell carcinomas are cured with surgery alone. In a study of 985 tumors followed for up to 10 years at Brigham and Women's Hospital, 4.6% recurred at the original site, 3.7% spread to lymph nodes, and 2.1% caused death [9]. The features that predicted spread and death were [9, 10]:

  • a diameter of 2 cm or more;

  • poor differentiation (cells that look very abnormal under the microscope);

  • invasion deeper than the fat under the skin, or into bone;

  • location on the ear or temple;

  • perineural invasion, meaning cancer growing along a nerve.

The more of these features a tumor has, the higher its risk. In a staging system built from this cohort, tumors with two or three of the first four features made up 19% of tumors but accounted for 72% of lymph node spread and 83% of deaths [10].

Surgery. For low-risk tumors, standard excision with a rim (margin) of 4 to 6 mm of normal-appearing skin is appropriate. For high-risk tumors, and for many tumors on the face where tissue must be conserved, Mohs surgery or excision with complete margin assessment is preferred [11]. Mohs surgery is described in the basal cell carcinoma section below.

Spread to lymph nodes and the parotid gland. Squamous cell carcinomas of the scalp, forehead, temple and ear drain to lymph nodes in and around the parotid gland and in the neck. When cancer is found in these nodes, treatment usually includes parotidectomy and neck dissection, followed by radiation therapy. Large tumors, tumors with nerve involvement, and tumors that have spread to nodes are often treated with radiation after surgery [11]. In a multicenter study of 349 patients with advanced squamous cell carcinoma of the head and neck, radiation after surgery was associated with better survival in those with perineural invasion or lymph node spread [12]. The evaluation of a lump in the neck is described on the neck tumors page.

Immunotherapy. Cemiplimab is an immunotherapy drug (a PD-1 inhibitor) that helps the immune system recognize cancer. In patients with squamous cell carcinoma that had spread or could not be removed, about half responded to cemiplimab, often for a long time [13]. In a 2025 randomized trial of 415 patients with high-risk squamous cell carcinoma who had already had surgery and radiation, adding cemiplimab lowered the risk of recurrence or death by about two-thirds; 87% of patients were free of disease at two years, compared with 64% with placebo [14]. Serious side effects were more common with cemiplimab. More information is on the immunotherapy page.

basal cell carcinoma

Basal cell carcinoma (BCC), also known as basal cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it. It may also present as a raised area with ulceration. Basal-cell cancer grows slowly and can damage the tissue around it, but it is unlikely to spread to distant areas or result in death. Occasionally, a cancer can have microscopic features of both basal cell carcinoma and squamous cell carcinoma, and these behave like squamous cell carcinoma.

Risk factors include exposure to ultraviolet light, having lighter skin, radiation therapy, long-term exposure to arsenic and poor immune-system function. Exposure to UV light during childhood is particularly harmful. Tanning beds have become another common source of ultraviolet radiation. Diagnosis often depends on skin examination, confirmed by tissue biopsy.

It remains unclear whether sunscreen affects the risk of basal-cell cancer. Treatment is typically by surgical removal. Other options for small basal cell carcinomas or for patients who cannot undergo surgery include electrodesiccation and curettage, cryosurgery, topical chemotherapy, photodynamic therapy, laser surgery or the use of imiquimod, a topical immune-activating medication.

Basal-cell cancer accounts for at least 32% of all cancers globally. In the United States, about 35% of white males and 25% of white females are affected by BCC at some point in their lives.

Sunscreen and basal cell carcinoma. In the Nambour randomized trial, daily sunscreen reduced squamous cell carcinoma but did not measurably reduce basal cell carcinoma over 4.5 years [2]. Sun protection is still recommended, since UV light is the main cause.

Choosing a treatment. Guidelines from the American Academy of Dermatology sort basal cell carcinomas into low-risk and high-risk groups based on size, location, subtype under the microscope, whether the tumor is recurrent, and the patient's immune status [15]. Tumors in the central face, around the eyes, nose, lips and ears, are considered higher risk because recurrence there is more common and more difficult to repair. Surgery remains the most reliable treatment.

Mohs surgery. In Mohs micrographic surgery, the tumor is removed in thin layers and the entire edge of each layer is examined under the microscope while the patient waits. Additional tissue is removed only where cancer remains. This spares normal skin, which matters on the face. In a randomized trial of facial basal cell carcinomas with 10 years of follow-up, recurrence after Mohs surgery was 4.4% for first-time tumors versus 12.2% after standard excision, a difference that did not reach statistical significance; for tumors that had already recurred, Mohs was clearly better (3.9% versus 13.5%) [16, 17]. Many recurrences appeared more than 5 years after treatment, which is one reason long-term skin checks matter [17].

Imiquimod cream. For small superficial or nodular basal cell carcinomas at low-risk sites, imiquimod cream is an alternative to surgery. In the SINS randomized trial, 82.5% of tumors treated with imiquimod were cleared at 5 years, compared with 97.7% after surgery [18]. Imiquimod is less effective than surgery but avoids a scar, and most failures become apparent in the first year.

Advanced basal cell carcinoma. Rarely, basal cell carcinoma grows deeply into the face or orbit, or spreads. Vismodegib, a pill that blocks the hedgehog signaling pathway that drives these tumors, shrank 43% of locally advanced and 30% of metastatic basal cell carcinomas in its pivotal trial [19]. Side effects such as muscle cramps, hair loss and loss of taste are common.

MELANOMA

Melanoma, also known as malignant melanoma, is a type of skin cancer that develops from the pigment-producing cells known as melanocytes. Melanomas typically occur in the skin but may rarely occur in the mouth, lining of the sinuses or nose, intestines or eye. In women, they most commonly occur on the legs, while in men they most commonly occur on the back. About 25% of melanomas develop from moles. Changes in a mole that can indicate melanoma include an increase in size, irregular edges, change in color, itchiness or skin breakdown.

The primary cause of melanoma is ultraviolet light (UV) exposure in those with low levels of the skin pigment melanin. The UV light may be from the sun or other sources, such as tanning devices. Those with many moles, a history of affected family members and poor immune function are at greater risk. A number of rare genetic conditions such as xeroderma pigmentosum also increase the risk. Diagnosis is by biopsy and analysis of any skin lesion that has signs of being potentially cancerous. Note of any surface ulceration before biopsy is meaningful for staging, and the biopsy of choice is a full thickness skin “punch” biopsy so that the depth of the lesion may be measured.

Using sunscreen and avoiding UV light may prevent melanoma. Treatment is typically removal by surgery. In those with slightly larger cancers, nearby lymph nodes may be tested for spread (metastasis). Most people are cured if spread has not occurred. For those in whom melanoma has spread, immunotherapy, biologic therapy, radiation therapy or chemotherapy may improve survival. With treatment, the five-year survival rates in the United States are 99% among those with localized disease, 65% when the disease has spread to lymph nodes and 25% among those with distant spread. The likelihood that melanoma will reoccur or spread depends on its thickness, how fast the cells are dividing and whether or not the overlying skin has broken down (ulcerated).

Melanoma is the most dangerous type of skin cancer. Globally, in 2012, it newly occurred in 232,000 people. In 2015, there were 3.1 million people with active disease, which resulted in 59,800 deaths. Australia and New Zealand have the highest rates of melanoma in the world. There are also high rates in Northern Europe and North America, while it is less common in Asia, Africa and Latin America. In the United States melanoma occurs about 1.6 times more often in men than women. Melanoma has become more common since the 1960s in areas mostly populated by people of European descent.

• This link goes to the American Cancer Society interactive website with text and diagrams on melanoma skin cancer.

• Here is an article from the American Academy of Dermatology describing how to perform a self-exam of your skin and what findings are suspect for melanoma.

• This YouTube video by the American Cancer Society explains sentinel lymph node biopsy for melanoma.

Staging. Melanoma is staged with the American Joint Committee on Cancer (AJCC) system. For the primary tumor, the two most important features are its thickness, measured in millimeters from the surface down (Breslow depth), and whether the surface is ulcerated [20]. Spread to lymph nodes and to distant sites completes the stage. Melanoma can also arise in the lining of the nose, sinuses and mouth; this mucosal melanoma behaves differently and is staged separately.

Surgical margins. After the biopsy confirms melanoma, the site is re-excised with a margin of normal skin that depends on the thickness of the tumor. American Academy of Dermatology guidelines recommend [21]:

  • melanoma in situ (confined to the top layer of skin): 0.5 to 1 cm;

  • up to 1 mm thick: 1 cm;

  • 1.01 to 2 mm thick: 1 to 2 cm;

  • more than 2 mm thick: 2 cm.

On the face, these margins are sometimes adjusted to protect the eye, nose or lip, and staged excision with careful margin checks may be used for melanoma in situ on sun-damaged skin [21].

Sentinel lymph node biopsy. The sentinel node is the first lymph node that drains the area of the tumor. It is found by injecting a tracer next to the melanoma and then removed through a small incision. In the MSLT-I trial, sentinel node biopsy did not improve melanoma-specific survival for the whole group, but it gave important staging information and improved disease-free survival for intermediate and thick melanomas [22]. Sentinel node biopsy is generally discussed for melanomas thicker than 0.8 mm or with ulceration, and recommended for most melanomas thicker than 1 mm [21, 20]. In the head and neck, the sentinel node can lie in the parotid gland or the neck. More on lymph nodes is on the lymphatics page.

When the sentinel node contains melanoma. In the past, all of the remaining nodes in that region were removed (completion dissection). Two randomized trials, MSLT-II and DeCOG-SLT, showed that completion dissection did not improve melanoma-specific survival compared with close monitoring with ultrasound [23, 24]. Most patients with a positive sentinel node are now monitored with ultrasound rather than undergoing immediate dissection, which also avoids the lymphedema that followed dissection in about one quarter of patients [23].

Treatment after surgery (adjuvant therapy). For melanoma that has spread to lymph nodes and been removed, a year of immunotherapy lowers the risk of recurrence. In the KEYNOTE-054 trial, pembrolizumab after surgery improved one-year recurrence-free survival from 61% to 75% [25]. For patients with large nodal disease that can be removed, giving pembrolizumab before surgery as well as after (neoadjuvant therapy) improved two-year event-free survival from 49% to 72% compared with giving it only after surgery [26].

Advanced melanoma. Before immunotherapy, few people with melanoma that had spread widely lived longer than a year or two. In the CheckMate 067 trial, the combination of nivolumab and ipilimumab produced a median overall survival of about 6 years, and among patients who were alive without progression at 3 years, 96% were still alive and free of death from melanoma at 10 years [27]. Melanomas with a BRAF gene mutation can also be treated with targeted pills. These treatments are described on the chemotherapy and immunotherapy page and the melanoma treatments page.

Merkel cell carcinoma

• Merkel cell carcinoma is an uncommon type of skin cancer mostly found on the cheeks of an individual of greater than 75 years of age. It behaves aggressively like melanoma, but is more responsive to radiation than melanoma.

• This link goes to the American Cancer Society interactive website on Merkel cell cancer with illustrations and text.

How common it is. About 2,500 Merkel cell carcinomas were diagnosed each year in the United States in 2013, and the number is rising as the population ages. The risk climbs steeply with age, from about 1 per million people per year in the early 40s to nearly 1 per 10,000 per year after age 85 [28].

Causes. Merkel cell carcinoma has two causes. In most cases in North America and Europe, a common virus, Merkel cell polyomavirus, has integrated into the tumor's DNA. In the rest, typically in areas of heavy sun exposure, the cancer is driven by UV damage [29]. A weakened immune system raises the risk and the chance of recurrence [30]. The cancer usually appears as a firm, painless, fast-growing red or purple bump.

Spread and recurrence. About 30% of patients already have spread to nearby lymph nodes at diagnosis [29]. For that reason, sentinel lymph node biopsy is usually done at the time the primary tumor is removed, even when the neck feels normal. In a study of 618 patients, 40% had a recurrence within 5 years, and 95% of recurrences occurred within the first 3 years [30]. Close follow-up, often with imaging, is most important during those first years.

Treatment. Treatment usually combines surgical excision, sentinel lymph node biopsy, and radiation therapy to the tumor site and, when needed, the lymph nodes [29]. When surgery is not possible, radiation alone can often control the cancer. For cancer that has spread, immunotherapy has replaced chemotherapy as the first treatment: as the first therapy for advanced disease, pembrolizumab produced responses in 56% of patients and avelumab in 62% [31, 32]. These responses tend to last much longer than those seen with chemotherapy.

Repairing the skin after cancer removal

Once the cancer has been removed and the margins confirmed clear, the wound is repaired. Small wounds are closed side to side in a line that follows the natural creases of the face. Larger wounds may be closed with a local flap, in which nearby skin is moved into the defect while keeping its own blood supply, or with a skin graft taken from another site. Some wounds are allowed to heal on their own. The choice depends on the size and location of the wound and on the patient's priorities. What to expect after surgery is described on the skin excision, flap and graft recovery page, and options for improving a scar afterward are on the scar treatment page.

Summary

  • Skin cancer is the most common cancer, and the head and neck are the most common site.

  • Daily sunscreen reduced squamous cell carcinoma and melanoma in a randomized trial; tanning beds increase melanoma risk.

  • Basal cell carcinoma rarely spreads; surgery, including Mohs surgery for high-risk facial tumors, is the most reliable treatment.

  • Most squamous cell carcinomas are cured with surgery. Large, deep, poorly differentiated or nerve-involving tumors, and tumors of the ear and temple, carry a higher risk of spread to the parotid and neck lymph nodes.

  • Melanoma risk depends mainly on thickness and ulceration. Sentinel node biopsy stages the lymph nodes, completion dissection is rarely needed, and immunotherapy has greatly improved outcomes for advanced disease.

  • Merkel cell carcinoma is rare and aggressive, is usually treated with surgery, sentinel node biopsy and radiation, and responds well to immunotherapy when advanced.

  • Repair of the skin after removal is planned to preserve the function and appearance of the face.

References

  1. Rogers HW, Weinstock MA, Feldman SR, et al. Incidence Estimate of Nonmelanoma Skin Cancer (Keratinocyte Carcinomas) in the U.S. Population, 2012. JAMA Dermatol. 2015. doi:10.1001/jamadermatol.2015.1187. PubMed: 25928283

  2. Green A, Williams G, Neale R, et al. Daily sunscreen application and betacarotene supplementation in prevention of basal-cell and squamous-cell carcinomas of the skin: a randomised controlled trial. Lancet. 1999. doi:10.1016/S0140-6736(98)12168-2. PubMed: 10475183

  3. Green AC, Williams GM, Logan V, et al. Reduced melanoma after regular sunscreen use: randomized trial follow-up. J Clin Oncol. 2011. doi:10.1200/JCO.2010.28.7078. PubMed: 21135266

  4. Boniol M, Autier P, Boyle P, et al. Cutaneous melanoma attributable to sunbed use: systematic review and meta-analysis. BMJ. 2012. doi:10.1136/bmj.e4757. PubMed: 22833605

  5. Chen AC, Martin AJ, Choy B, et al. A Phase 3 Randomized Trial of Nicotinamide for Skin-Cancer Chemoprevention. N Engl J Med. 2015. doi:10.1056/NEJMoa1506197. PubMed: 26488693

  6. Allen NC, Martin AJ, Snaidr VA, et al. Nicotinamide for Skin-Cancer Chemoprevention in Transplant Recipients. N Engl J Med. 2023. doi:10.1056/NEJMoa2203086. PubMed: 36856616

  7. US Preventive Services Task Force, Mangione CM, Barry MJ, et al. Screening for Skin Cancer: US Preventive Services Task Force Recommendation Statement. JAMA. 2023. doi:10.1001/jama.2023.4342. PubMed: 37071089

  8. Euvrard S, Kanitakis J, Claudy A. Skin cancers after organ transplantation. N Engl J Med. 2003. doi:10.1056/NEJMra022137. PubMed: 12711744

  9. Schmults CD, Karia PS, Carter JB, et al. Factors predictive of recurrence and death from cutaneous squamous cell carcinoma: a 10-year, single-institution cohort study. JAMA Dermatol. 2013. doi:10.1001/jamadermatol.2013.2139. PubMed: 23677079

  10. Jambusaria-Pahlajani A, Kanetsky PA, Karia PS, et al. Evaluation of AJCC tumor staging for cutaneous squamous cell carcinoma and a proposed alternative tumor staging system. JAMA Dermatol. 2013. doi:10.1001/jamadermatol.2013.2456. PubMed: 23325457

  11. Alam M, Armstrong A, Baum C, et al. Guidelines of care for the management of cutaneous squamous cell carcinoma. J Am Acad Dermatol. 2018. doi:10.1016/j.jaad.2017.10.007. PubMed: 29331386

  12. Harris BN, Pipkorn P, Nguyen KNB, et al. Association of Adjuvant Radiation Therapy With Survival in Patients With Advanced Cutaneous Squamous Cell Carcinoma of the Head and Neck. JAMA Otolaryngol Head Neck Surg. 2019. doi:10.1001/jamaoto.2018.3650. PubMed: 30570645

  13. Migden MR, Rischin D, Schmults CD, et al. PD-1 Blockade with Cemiplimab in Advanced Cutaneous Squamous-Cell Carcinoma. N Engl J Med. 2018. doi:10.1056/NEJMoa1805131. PubMed: 29863979

  14. Rischin D, Porceddu S, Day F, et al. Adjuvant Cemiplimab or Placebo in High-Risk Cutaneous Squamous-Cell Carcinoma. N Engl J Med. 2025. doi:10.1056/NEJMoa2502449. PubMed: 40454639

  15. Bichakjian C, Armstrong A, Baum C, et al. Guidelines of care for the management of basal cell carcinoma. J Am Acad Dermatol. 2018. doi:10.1016/j.jaad.2017.10.006. PubMed: 29331385

  16. Mosterd K, Krekels GA, Nieman FH, et al. Surgical excision versus Mohs' micrographic surgery for primary and recurrent basal-cell carcinoma of the face: a prospective randomised controlled trial with 5-years' follow-up. Lancet Oncol. 2008. doi:10.1016/S1470-2045(08)70260-2. PubMed: 19010733

  17. van Loo E, Mosterd K, Krekels GA, et al. Surgical excision versus Mohs' micrographic surgery for basal cell carcinoma of the face: A randomised clinical trial with 10 year follow-up. Eur J Cancer. 2014. doi:10.1016/j.ejca.2014.08.018. PubMed: 25262378

  18. Williams HC, Bath-Hextall F, Ozolins M, et al. Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma: 5-Year Results of the SINS Randomized Controlled Trial. J Invest Dermatol. 2017. doi:10.1016/j.jid.2016.10.019. PubMed: 27932240

  19. Sekulic A, Migden MR, Oro AE, et al. Efficacy and safety of vismodegib in advanced basal-cell carcinoma. N Engl J Med. 2012. doi:10.1056/NEJMoa1113713. PubMed: 22670903

  20. Gershenwald JE, Scolyer RA, Hess KR, et al. Melanoma staging: Evidence-based changes in the American Joint Committee on Cancer eighth edition cancer staging manual. CA Cancer J Clin. 2017. doi:10.3322/caac.21409. PubMed: 29028110

  21. Swetter SM, Tsao H, Bichakjian CK, et al. Guidelines of care for the management of primary cutaneous melanoma. J Am Acad Dermatol. 2019. doi:10.1016/j.jaad.2018.08.055. PubMed: 30392755

  22. Morton DL, Thompson JF, Cochran AJ, et al. Final trial report of sentinel-node biopsy versus nodal observation in melanoma. N Engl J Med. 2014. doi:10.1056/NEJMoa1310460. PubMed: 24521106

  23. Faries MB, Thompson JF, Cochran AJ, et al. Completion Dissection or Observation for Sentinel-Node Metastasis in Melanoma. N Engl J Med. 2017. doi:10.1056/NEJMoa1613210. PubMed: 28591523

  24. Leiter U, Stadler R, Mauch C, et al. Complete lymph node dissection versus no dissection in patients with sentinel lymph node biopsy positive melanoma (DeCOG-SLT): a multicentre, randomised, phase 3 trial. Lancet Oncol. 2016. doi:10.1016/S1470-2045(16)00141-8. PubMed: 27161539

  25. Eggermont AMM, Blank CU, Mandala M, et al. Adjuvant Pembrolizumab versus Placebo in Resected Stage III Melanoma. N Engl J Med. 2018. doi:10.1056/NEJMoa1802357. PubMed: 29658430

  26. Patel SP, Othus M, Chen Y, et al. Neoadjuvant-Adjuvant or Adjuvant-Only Pembrolizumab in Advanced Melanoma. N Engl J Med. 2023. doi:10.1056/NEJMoa2211437. PubMed: 36856617

  27. Wolchok JD, Chiarion-Sileni V, Rutkowski P, et al. Final, 10-Year Outcomes with Nivolumab plus Ipilimumab in Advanced Melanoma. N Engl J Med. 2025. doi:10.1056/NEJMoa2407417. PubMed: 39282897

  28. Paulson KG, Park SY, Vandeven NA, et al. Merkel cell carcinoma: Current US incidence and projected increases based on changing demographics. J Am Acad Dermatol. 2018. doi:10.1016/j.jaad.2017.10.028. PubMed: 29102486

  29. Becker JC, Stang A, DeCaprio JA, et al. Merkel cell carcinoma. Nat Rev Dis Primers. 2017. doi:10.1038/nrdp.2017.77. PubMed: 29072302

  30. McEvoy AM, Lachance K, Hippe DS, et al. Recurrence and Mortality Risk of Merkel Cell Carcinoma by Cancer Stage and Time From Diagnosis. JAMA Dermatol. 2022. doi:10.1001/jamadermatol.2021.6096. PubMed: 35195657

  31. Nghiem PT, Bhatia S, Lipson EJ, et al. PD-1 Blockade with Pembrolizumab in Advanced Merkel-Cell Carcinoma. N Engl J Med. 2016. doi:10.1056/NEJMoa1603702. PubMed: 27093365

  32. D'Angelo SP, Russell J, Lebbé C, et al. Efficacy and Safety of First-line Avelumab Treatment in Patients With Stage IV Metastatic Merkel Cell Carcinoma: A Preplanned Interim Analysis of a Clinical Trial. JAMA Oncol. 2018. doi:10.1001/jamaoncol.2018.0077. PubMed: 29566106

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