Skin cancer is one of the most common cancers worldwide, with over 1.5 million new cases recorded in 2022, according to the World Health Organization. Alarmingly, incidence rates have risen sharply over the past few decades, due to higher sun and ultraviolet (UV) exposure, among other risk factors. But there is cause for hope: skin cancer doctors are developing ever more innovative treatments to tackle the issue head on. We spoke to Olivier Gaide, professor and doctor of dermatology, and Sofiya Latifyan, oncologist, about their work, including at the Lausanne University Hospital’s (CHUV’s) new Centre des mélanomes et tumeurs cutanées.

Skin cancer is a massive, diverse field. As Olivier explained to us: ‘There are as many cancers as there are different cell types – every cell that you find in the skin can unfortunately become cancerous. As a whole, skin cancer accounts for at least a third of our work as dermatologists.’

Indeed, anyone can develop skin cancer, though the risks are higher among people with a fair complexion, a history of sunburns, outdoor professions, weakened immune systems or even advanced age. Age is becoming an increasingly important factor given the ageing of the global population, especially the Caucasian population. As Olivier shared with us, ‘even if you lived in a cellar and you were never exposed to UV light, there would still be a chance of you developing an age-related skin cancer, though this would be a rare event’.

It must be said that the primary driver of skin cancer is exposure to UV radiation, which damages DNA and promotes mutations. The majority of cases arise from keratinocytes, the most common cell in the upper layer of the skin (the epidermis), leading to basal and squamous cell carcinomas. Meanwhile, melanoma, derived from melanocytes, is less frequent but much more dangerous.

The importance of prevention alongside diverse treatment options

The best way to tackle skin cancer is to prevent it occurring in the first place. This doesn’t mean avoiding the sun altogether – that would be ‘counterproductive’, in Olivier’s eyes – but rather adopting sensible habits to minimise exposure to UV. ‘The key is to prevent sunburn, especially in childhood, and to avoid repetitive or intense sun exposure that damages the skin over time,’ Olivier said. ‘Measures such as banning children from using tanning beds, as recently done in Switzerland, mark a step in the right direction in terms of prevention.’

Early detection also greatly improves outcomes. Olivier stressed the importance of regularly checking your skin and consulting a doctor as soon as you notice any unusual changes, since skin cancers that are caught early are often easy to treat.

Thankfully, when cancer does arise, there is now a suite of treatment options available to patients. Surgery remains the first port of call, and is, according to Olivier, ‘extremely effective’ for tumours that can be removed in full – the only downside is scarring, though surgeons are now trained on how to minimise the aesthetic impact of scars.

When further treatment is needed, doctors must work together to decide on the most effective pathway, as evoked by Sofiya: ‘It’s great when the cancer can simply be treated with surgery and there’s no need for an oncologist. However, when skin cancer has metastasised or requires additional intervention, treatment becomes a collaborative effort between dermatologists, surgeons and oncologists.’

Modern oncological treatments include immunotherapy, which stimulates the patient’s immune system to recognise and attack cancer cells that were previously ‘invisible’ to immune defences. Employed before or after surgery, immunotherapy has significantly improved survival rates and reduced the risk of relapsing, especially for melanoma, alongside other types of skin cancer. ‘We’re thrilled to be able to offer a treatment that gives people a real chance to live a life without cancer,’ said Sofiya.

Targeted systemic therapies and even radiotherapy can also be implemented alongside surgery and immunotherapy, while chemotherapy is now reserved for exceptional circumstances. Joint efforts allow for tailored, effective and increasingly patient-friendly treatment plans.

Revolutionising the patient experience with fully integrated treatment pathways

Offering an integrative approach to patients is exactly what the CHUV’s new Centre des mélanomes et tumeurs cutanées seeks to do. It brings together resources and specialists from a range of fields – head and neck, digestion, aesthetics, oncology and dermatology, to name just a few – to enable truly coordinated, patient-centric care. As Olivier put it, ‘our mission is to anticipate each patient’s needs and deliver highly individualised, evidence-based treatment’.

At the core of the centre’s model is the multidisciplinary tumour board, which meets regularly to discuss individual patients. ‘Every patient that qualifies for the centre will be presented at some point to the tumour board, which not only allows for better treatment coordination but also opportunities to put them forward for clinical trials,’ Olivier said. ‘Often, there are clinical trials going on but not all specialists know about them. By breaking down silos between departments and creating a space for open discussion, we make sure as many patients as possible are benefitting from innovative treatments. It’s also good for research.’

Indeed, Sofiya highlighted how widespread coordination drives positive outcomes for everyone: ‘We work directly with research teams to integrate strategies like cellular treatments, antibody conjugates and vaccines into clinical practice, speeding up the adoption of new treatments while also ensuring that patients are receiving exceptionally high-quality, specialised care. What’s more, we collaborate within the CHUV, but we also work closely with our colleagues from other Swiss skin cancer centres – for me, sharing knowledge across disciplines and centres is the key to fighting cancer.’

In this fight, the main focus continues to be patients, of which over 20,000 are diagnosed with skin cancer in Switzerland every year. Everything in the Centre des mélanomes et tumeurs cutanées has been set up to support patient well-being. Two designated nurses serve as essential points of contact for each patient and accompany them from diagnosis through every stage of care. ‘There can be distance between doctors and patients,’ Sofiya shared, ‘but the reference nurses act as a bridge, ensuring continuity, clarifying complex information and providing a space for patients to ask personal or practical questions – about work, family or everyday life during treatment, for example. This continuous support makes care not only more efficient but also more humane.’ Both Olivier and Sofiya were proud to be engaged in this new model of skin cancer care.

Looking to the future: Democratising treatment and shifting cultural attitudes

Integrated cancer centres with multidisciplinary tumour boards undoubtedly now represent the gold standard of modern cancer treatment. Unfortunately, the cost of employing a range of experts alongside funding new therapies remains prohibitive for many low- and middle-income countries.

That said, advanced cancer centres are working to drive things in the right direction. Olivier evoked the CHUV’s collaboration with the Regional Dermatology Training Center in Moshi, Tanzania, which trains specialists across sub-Saharan Africa. Such initiatives strengthen local expertise, foster self-sufficiency and eventually enable underserved countries to produce their own affordable medicines.

We also must not ignore the need for cultural change at home. Olivier pointed to the fact that, despite widespread awareness of the dangers of UV exposure in Western Europe, people continue to tan to excess: ‘It’s striking that people do not act on the knowledge they have. We see the same with smoking – most people know that tobacco is bad for their health and yet 30% of the Swiss population still smoke.’ In short, increased public awareness around skin health remains a vital frontier for the years ahead.

So, there are clearly still battles to win in the global fight against cancer. But Olivier stressed that there were new developments around every corner: ‘It’s a hugely active, very exciting field to work in. It’s not like we’ve reached the pinnacle and now we’re waiting for the descent – new treatments and tools are arriving every month. It’s amazing that when I first started working, metastatic melanoma patients were basically condemned – but now we cure about half of them.’ Sofiya agreed: ‘We are delighted to be part of this change and can’t wait to see where we will go next in terms of efficacy.’