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Non-Melanoma Skin Cancer: Promises and Challenges

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Dear Colleagues,

Non-melanoma skin cancer (NMSC)—which primarily includes basal cell carcinoma (BCC) and squamous cell carcinoma (SCC)—is the most common form of cancer worldwide.

Management of NMSC is rapidly evolving, with a shift toward more personalized and less invasive approaches and increasing focus on early detection and immunotherapy for advanced disease. Despite these advances, significant challenges remain. The global incidence of NMSC continues to rise, and issues such as treatment resistance, long-term toxicity and disparities in access to care present ongoing obstacles. Addressing these complexities requires a multidisciplinary approach that integrates dermatology, medical oncology, radiation oncology, artificial intelligence (AI) and public health strategies.

This Special Issue aims to showcase original research articles, translational studies and reviews that highlight recent progress in the diagnosis, treatment and long-term management of NMSC. Topics of interest include, but are not limited to, the following:

Precision medicine and molecular targeting;
Minimally invasive techniques;
Immunotherapy and radiotherapy;
Patient-reported outcomes;
Brachytherapy and flash therapy;
Follow-up strategies;
Biomarkers and patient stratification;
AI-assisted early detection;
Management in special populations (e.g., elderly and immunocompromised patients);
Treatment resistance and toxicity.

Through this collection, we hope to provide a comprehensive overview of current advances and future directions in the field of NMSC.

Dr. Francesca De Felice
Dr. Valerio Nardone
Guest Editors

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16 pages, 1469 KB

Open AccessArticle

Seeing More to Treat Better: Ultra-High Frequency Ultrasound as a Decision-Shaping Tool in Radiotherapy for Head and Neck Non-Melanoma Skin Cancer in a Single-Institution Feasibility Study

by Emma D’Ippolito, Anna Russo, Luca Marinelli, Vittorio Patanè, Federico Gagliardi, Vittorio Salvatore Menditti, Angelo Sangiovanni, Nicola Maria Tarantino, Valerio Nardone and Alfonso Reginelli

Cancers 2026, 18(7), 1083; https://doi.org/10.3390/cancers18071083 - 26 Mar 2026

Viewed by 458

Abstract

Background/Objectives: Accurate target delineation is critical in radiotherapy for head and neck non-melanoma skin cancer (NMSC), where tumor depth and subclinical extension are often underestimated by clinical and dermoscopic assessment alone. While high frequency ultrasound has shown value in surface-based radiotherapy techniques, the role of ultra-high frequency ultrasound (UHFUS) within external beam radiotherapy (EBRT) workflows remains poorly defined. Methods: We conducted a single-institution observational feasibility study including all consecutive patients with head and neck NMSC treated with definitive or adjuvant radiotherapy between July 2022 and July 2023 using a structured multidisciplinary workflow integrating pre-treatment UHFUS. UHFUS was systematically performed prior to CT simulation and incorporated into radiotherapy planning. The primary endpoint was the impact of UHFUS on radiotherapy decision-making, predefined as modification of target delineation, treatment intent, or beam modality selection. Secondary endpoints included feasibility, early local control, and late toxicity (descriptive). Results: Thirty patients were included (median age 85 years; range 66–99). UHFUS influenced at least one decision endpoint in 13 patients (43.3%). In the definitive radiotherapy cohort (n = 18), UHFUS modified gross tumor volume delineation in eight patients (44.4%), with an increase in median GTV from 17.5 cm³ to 24.3 cm³. Among patients initially referred for adjuvant radiotherapy (n = 12), UHFUS identified macroscopic residual disease in two cases, leading to a change in treatment intent from adjuvant to definitive radiotherapy. UHFUS supported beam modality selection in three patients by enabling safe use of electron therapy for superficial lesions. After a median follow-up of 24 months (range 12–24), no local recurrences were observed. Late toxicity was limited to grade 1 cutaneous events. Conclusions: Integration of UHFUS into EBRT planning for head and neck NMSC is feasible and clinically informative. UHFUS acts as a decision-shaping tool, influencing target delineation, treatment intent, and modality selection within a multidisciplinary workflow. These findings support further prospective evaluation of UHFUS-guided radiotherapy planning to standardize decision algorithms and assess long-term clinical impact. Full article

(This article belongs to the Special Issue Non-Melanoma Skin Cancer: Promises and Challenges)

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