Balancing Efficacy and Tolerability in Skin Cancer Treatment: Todd Schlesinger, MD

This content was developed independently and is not endorsed by the American Academy of Dermatology.

In part 2 of an interview at the American Academy of Dermatology Annual Meeting, Todd Schlesinger, MD, founder and director of both the Dermatology & Laser Center of Charleston and the Clinical Research Center of the Carolinas, discussed emerging treatment strategies for patients with skin cancer who do not respond to or progress on current therapies, as well as how to balance efficacy with tolerability.

If a patient’s melanoma progresses on immunotherapy, he explained that next steps may include enrolling in a clinical trial, switching to another immunotherapy, or reconsidering surgery. Schlesinger noted that these decisions depend on factors such as cancer type, prior treatments, and any adverse events.

He also emphasized that adverse event management is critical for both immunotherapy and hedgehog pathway inhibitors. For basal cell carcinoma, strategies focus on prevention by optimizing patient health before treatment and using supportive measures like nutritional supplements to reduce adverse effects. Similarly, with immunotherapy, the emphasis is on ensuring patients are as healthy as possible, closely monitoring for early signs of adverse events, and managing them promptly.

Overall, Schlesinger stressed that proactive care helps patients remain on treatment long enough to benefit while also distinguishing adverse effects from other medical issues or disease recurrence.

“Those are the main things that we want to do make sure our patients are healthy, stay healthy, and can stay on medication long enough to see the benefit,” he concluded.

These responses build on his insights from part 1, in which he highlighted the importance of improving risk stratification and integrating emerging immunotherapies within multidisciplinary care models. Although dermatologists should remain central in ongoing management, Schlesinger emphasized the importance of close collaboration with surgical, radiation, and medical oncology, as well as social workers, advanced practice providers, office staff, and patients’ families.

He concluded by noting that coordinated, multidisciplinary teams are essential in advanced skin cancer care to align risk assessment, treatment selection, toxicity management, and supportive care in an era of rapidly evolving immunotherapy options.