Shannon C. Trotter, DO, is a dermatologist and podcast host from Springfield, Ohio.

Shannon C. Trotter, DO

Dermatologists are often the first to detect advanced cutaneous squamous cell carcinoma and should stay involved after oncology referral.

Pembrolizumab, cemiplimab, and cosibelimab are approved immune checkpoint inhibitors for locally advanced and metastatic disease.

Proposed Medicare cuts could delay skin cancer diagnosis and treatment for older patients.

Dermatologists should stay engaged in caring for patients with locally advanced and metastatic cutaneous squamous cell carcinoma (cSCC), even after referral to oncology, according to Shannon C. Trotter, DO, FAOCD, a board-certified dermatologist with Dermatologists of the Central States in Ohio.

, Trotter discussed immunotherapy options for advanced cSCC, proposed Medicare cuts, and the future of artificial intelligence (AI) in skin cancer care.

Why Dermatologists Should Stay Involved in Advanced Cutaneous SCC

On October 10, at the Fall Clinical Dermatology Conference in Las Vegas, Nevada, Trotter and Todd E. Schlesinger, MD, copresented “Seminar-In-Depth: Deep Dive on Cutaneous Squamous Cell Carcinoma and the Latest in Immunotherapy.”¹

Trotter noted about 95% of cSCC cases are treatable, while roughly 5% become more difficult to manage. She highlighted 3 immune checkpoint inhibitors approved for locally advanced and metastatic cSCC: pembrolizumab (Keytruda), cemiplimab (Libtayo), and cosibelimab (Unloxcyt). Research into intralesional use, particularly with cemiplimab, may also create a role for dermatologists in the office.

“They may seem far off to the dermatologist, but we are really the quarterbacks in skin cancer. We might be the first one to actually detect it, whether that is on the skin or even palpating for a lymph node. So we really need to be involved in our patients’ care, even if they are sent over to oncology as well,” Trotter said.

Trotter also described proposed Medicare cuts as a patient access issue. Older adults, who are disproportionately affected by skin cancer, could face delays in diagnosis and treatment. Survival in melanoma approaches 100% with early detection, she noted, and she encouraged the dermatology community to sign a petition opposing the cuts.

Looking ahead, Trotter pointed to augmented intelligence, which combines AI with clinician judgment, as a key opportunity in both melanoma and nonmelanoma skin cancer. New diagnostic tools may enable earlier detection. Gene expression profiling, alone or combined with AI, can provide prognostic information and may eventually guide therapeutic decisions.

Editor's Note: This summary has been edited for grammar and clarity using artificial intelligence tools. Trotter had no financial disclosures of note.

Schlesinger TE, Trotter SC. Seminar-in-depth: deep dive on cutaneous squamous cell carcinoma and the latest in immunotherapy. Presented at: 2026 Fall Clinical Dermatology Conference; October 8-11, 2026; Las Vegas, NV.

Videos

Shannon C. Trotter, DO, FAOCD, discusses immunotherapy in advanced cutaneous squamous cell carcinoma and why dermatologists should stay involved.

During this second segment of her on-site 

SDPA 2026 Annual Summer Dermatology Conference

 in Denver, Shannon Trotter, DO, FAOCD, spoke about some of the downstream consequences of dermatologic misinformation on the outcomes of patients, as well as providing a pointed takeaway for dermatology physician associates (PAs) and nurse practitioners (NPs) looking to push back against such concerns in their own practices.

Additionally, Trotter touched on some of the biggest insights from her second conference session, titled ‘Skin at Different Stages Track: Hormones and the Skin: Clinical Implications Across the Lifespan,’ which focused on hormones and the skin across the lifespan.

 This topic, she noted, is an increasingly relevant one given growing clinical and public attention to menopause, perimenopause, and andropause.

The following Q&A features responses to inquiries regarding misinformation and the aforementioned session on hormone impacts, outlining how hormonal fluctuations from adolescence through pregnancy and beyond manifest in the skin in ways that are frequently underestimated:

What impact can dermatology misinformation have on patient outcomes, treatment adherence, and expectations before patients walk into the office?

That's a great question. You know, social media has really influenced, I think, for a lot of patients, what's going to happen when we treat them. The biggest thing, from the expectation standpoint, is just the timeframe. People think everything gets better overnight, and most treatment regimens, whether it's for something as simple as acne or maybe even psoriasis, it takes time to see a difference.

You also need to have that consistency in keeping it simple, especially with skin care regimens. I think expectations for the timeframe are a big thing, and then also expectations for outcomes. There is this chase for perfection. I always like to tell people that the chase for perfection can actually halt progress. So, we also need to be realistic about what we expect to happen, and that there are a lot of chronic conditions too; they're going to have these ups and downs, but our goal is always to give you the best treatment and control possible.

What's one piece of advice you would kind of leave dermatology PAs and NPs with to more effectively address misinformation as they're walking away from your session?

I always tell you, even if you're not on social media, because I have to admit I'm a neophyte to the whole business of social media. But I was pulled into it more as a tool for work. What I always tell people, before you walk away, just admit to yourself that it's a reality. Don't ignore it and hide your head under the sand, because people are out there watching it, and they're apt to believe it more so maybe even than yourself.

Work on developing that trust and bond with your patients, maybe on your own social media. If that's not your thing, then provide a list of reputable folks, dermatologists out there, dermatology providers, APPs, and derms that you trust are giving accurate information, so you can direct your patients. You know that they're going to go and use it, so why not give them the best tools possible?

Switching gears, why did you feel the topics highlighted in your ‘Hormones and the Skin: Clinical Implications Across the Lifespan’ talk were important for clinicians in dermatology?

Yeah, I think this is a hot topic right now. First of all, there's a lot of attention, in particular, for women being drawn to menopause, perimenopause, all the changes that occur with it, including skin. So, it's on everyone's radar, and even for men, you know, there's some talk about andropause as well as the changes that men go through, too. That link to the skin, I think, is often underestimated, so I thought this is a really good time to really highlight skin, the endocrine system, and how it's connected.

What are some of the most important ways that hormones impact skin health throughout a patient's life? Like you said, from adolescence to menopause and beyond.

Yeah, it's pretty impressive. I always tell everyone this skin is an endocrine organ, and a lot of people have to stop and think about it and go, gosh, you know what, you're right, so all types of hormones in the body, whether it can be as simple as the thyroid, can impact our skin. That can impact dryness of the skin, or sweating, or even hair as well. Then, as we get more involved, especially for women, fluctuations in hormones can impact things like acne and hair loss, too.

Then, as we move forward into life with pregnancy, what a different change for hormones there, where certain conditions are more common during pregnancy. Then also, you know, things that move on further in life with menopause, that we've seen the changes that occur there, too. It's just throughout our lifespan, you're going to see all kinds of changes in hormones and how they vary more…Men tend to have more of a gradual decline in some of these changes, but that intimate relationship is definitely there with the skin.

Trotter reported no financial disclosures of note.

Trotter S. Skin at Different Stages Track: Hormones and the Skin: Clinical Implications Across the Lifespan. Session presented at SDPA Summer 2026; June 10–14.

Trotter S. Mythbusters in Dermatology: Helpful, Harmful, or Hype? Session presented at SDPA Summer 2026; June 10–14.

Articles

Dermatologic misinformation—amplified by social media—can distort expectations around treatment timelines and outcomes, undermining adherence and fueling a counterproductive “perfection” mindset, particularly for chronic, relapsing conditions. Clinicians are encouraged to acknowledge misinformation as pervasive, proactively build trust, and guide patients toward vetted educational sources, including credible social accounts. Hormonal physiology remains underappreciated in cutaneous medicine; skin functions as an endocrine organ responsive to thyroid and sex-hormone dynamics. Hormonal transitions across adolescence, pregnancy, and menopause/andropause influence acne, xerosis, sweating, and hair changes.

This interview segment from SDPA highlights insights on hormonal impacts on dermatology as well as other key highlights from sessions at the meeting.

What Are the Impacts of Hormones on Skin Health? With Shannon Trotter, DO

How Should Dermatology Clinicians Address Online Myths? With Shannon Trotter, DO

Society of Dermatology Physician Associates (SDPA) 2026 Annual Summer Dermatology Conference

 in Denver, Colorado, HCPLive’s editorial staff spoke in an interview with Shannon Trotter, DO, FAOCD, a board-certified dermatologist and skin cancer specialist with DOCS Dermatology and the Dermatologists of Central States in Ohio.

Trotter had presented a session titled "Mythbusters in Dermatology: Helpful, Harmful, or Hype."

, Trotter spoke about increases in dermatologic misinformation, why those seen in practice as patients are increasingly turning to social media for medical advice, and how clinicians can respond.

“There's just so much going on, especially online, about what patients hear about and what they think is truly fact and what we know is probably fiction,” Trotter expressed. “So, they come into the office with already an idea of how they want to be treated or their diagnosis, and I think that that's a good thing that people are more engaged in their health care. But the downside is some of those things could actually be hurtful for the patient.”

Although Trotter did acknowledge that increases in patient engagement in health care is broadly-speaking a positive development, she cautioned against some of the information driving this form of engagement. Trotter noted such misinformation is not only inaccurate but could even be dangerous, given the wide spectrum of myths patients bring into practices. 

On the more benign end of misinformation are longstanding folk remedies, Trotter stated, including the belief that applying toothpaste to a pimple will resolve it. In terms of concerning claims, Trotter pointed to the assertion that sunscreen causes skin cancer. This misconception, she stated, is particularly serious given the implications for skin cancer prevention in clinical practice.

Trotter cited a set of 3 converging factors leading to patients’ finding of misinoformation: convenience, entertainment value, and eroding trust in the medical system. She highlighted social media’s accessibility without an appointment, as it allows information in short, engaging formats to exist. In research she referenced, it is sometimes even trusted by some more than their own providers. This is a dynamic Trotter referred to as the most troubling aspect of the current landscape.

Among those seeking to counter misinformation, Trotter urged leading with evidence-based information. She also encouraged taking time to validate patients' views and fears, recognizing what drew them to a particular source or idea regarding treatment. Creating space for such a conversation, she posited, is essential to rebuilding trust and steering those who may have been led astray toward safer, data-supported care.

This interview at the SDPA Summer Conference highlights key myths and how to address them as a clinician in dermatology.

The Cost of Delay: How Prior Authorization Is Impacting Dermatology

 today, clinicians have access to an unprecedented array of biologics and targeted treatments designed to dramatically improving outcomes for individuals living with chronic inflammatory skin diseases such as atopic dermatitis, psoriasis, and hidradenitis suppurativa (HS).

However, according to 3 dermatologists interviewed by 

, gaining patients access to these drugs has evolved into a more and more complicated procedure. This, they and others in the field have noted, is due to prior authorization requirements, ‘step therapy’ protocols, and formulary restrictions caused by insurers and pharmacy benefit managers, also known as PBMs.

Prior authorization, the process by which health insurance plans go over and approve or deny various types of covered health services or medications, has evolved from an occasional administrative task into a routine part of practice management in dermatology.

 In this feature, the issues many clinicians have with the prior authorization process is explored, along with the potential need for future reforms.

Harrison Nguyen, MD, MBA, MPH, managing director of Harrison Dermatology & Research Group, was 1 such clinician who spoke with 

 about this complicated process as a substantial burden on both physicians and staff. While physicians may identify the most appropriate medication for a patient early in the visit, Nguyen highlighted the securing of a treatment’s approval as often requiring extensive paperwork, repeated communication with insurers, and dedicated personnel focused solely on navigating the authorization process.

Shannon Trotter, DO, known for her work with DOCS Dermatology Group, spoke with 

 about prior authorization, describing it as having long been a challenge in dermatology, though she highlighted the growing role of artificial intelligence (AI) in the process as both positive and negative. While AI tools can allow practices to better streamline submissions and diminish their own administrative workload, Trotter described insurers as also beginning to use similar technologies, creating what she described as an ongoing back-and-forth between providers and payers.

Outside of administrative burdens, all 3 of these clinicians emphasized the impact these barriers can have on patient care. Trotter pointed to step therapy requirements as a frequent source of delays, noting that patients may be required to try and fail therapies for months prior to gaining access to the medication their clinician originally recommended. During such time, a patient may continue experiencing symptoms that interfere with work, sleep, overall quality of life, or even becoming more debilitating.

Nguyen described formulary changes as also potentially forcing patients to switch from therapies that may already be working well. While some transitions occur without issue, he noted patients with conditions such as atopic dermatitis and HS can sometimes report disease worsening or loss of treatment response when required to shift between treatments for non-clinical reasons. In certain cases, Nguyen noted, interruptions in therapy can make future treatment far more challenging.

Matthew Zirwas, MD, a board-certified dermatologist at Dermatologists of Greater Columbus, spoke even more adamantly against prior authorization as a practice. Zirwas pointed to the growing number of available therapies as having intensified prior authorization challenges. He pointed to PBM rebate structures and limited transparency surrounding formulary decisions as key drivers of the issue, suggesting that treatment preferences often do not align with what clinicians believe is best for patients. Additionally, he noted his own view of the need for reforms that allow for incentives among PBMs to shift, as well as the need for more transparency.

Despite differences in emphasis, all 3 clinicians agreed that reform is needed. Proposed solutions included greater transparency around formulary and rebate decisions, streamlined authorization processes, improved peer-to-peer review systems, and reforms to step therapy requirements.

Overall, each of these 3 leaders in the field spoke in favor of a reduction of unnecessary barriers as helpful to ensure patients are given the right treatment at the right time, while nevertheless expressing the need to preserve access to the therapeutic advances known to have shaped the modern dermatologic landscape.

Disclosures: Trotter, Nguyen, and Zirwas had no relevant disclosures of note.

Amann ST, Shah ED, Wilson LJ. An Overview of the Challenging Process of Prior Authorization: Medical Necessity for a Better Way. Clin Gastroenterol Hepatol. 2024 Dec;22(12):2362-2366. doi: 10.1016/j.cgh.2024.09.001. Epub 2024 Sep 18. PMID: 39303798; PMCID: PMC11604005.

Sharma SP, Russo A, Deering T, Fisher J, Lakkireddy D. Prior Authorization: Problems and Solutions. JACC Clin Electrophysiol. 2020 Jun;6(6):747-750. doi: 10.1016/j.jacep.2020.04.022. PMID: 32553230.

Sampathkumar G. Rethinking prior authorization: bridging clinical needs and administrative burdens. Am J Manag Care. 2026 Feb 1;32(2):e31-e33. doi: 10.37765/ajmc.2026.89883. PMID: 41759204.

Kyle MA, Song Z. The Consequences and Future of Prior-Authorization Reform. N Engl J Med. 2023 Jul 27;389(4):291-293. doi: 10.1056/NEJMp2304447. Epub 2023 Jul 22. PMID: 37486761; PMCID: PMC10676707.

Wang Y, Levy JF, Mattingly TJ 2nd, Anderson G. Prior Authorization and Associated Delays and Denials of Branded Medication Dispensation. JAMA Health Forum. 2026 Apr 3;7(4):e260760. doi: 10.1001/jamahealthforum.2026.0760. PMID: 41996105; PMCID: PMC13090851.


This video feature highlights the views of dermatologists on prior authorization, step therapy, and issues related to these processes.