Cold open

Terry: Hi, I'm Terry Wilcox, and this is the State of the Patient Podcast.

Kay: In fact, I am the one that pointed it out to my dermatologist.

Mark: Lord, if they have to take that much off my nose, it'd be disfiguring.

Julie: Many in our community have thousands in their lifetime. I've had probably around a thousand.

Dr. Bokhari: An uncomplicated Mohs procedure, a median cost is $3,000, $4,000. $1,000 would be very attractive.

Welcome

Terry: Hi, I'm Terry Wilcox, and this is the State of the Patient. It's the middle of summer — more hours outside than at any other point in the year — and most of us aren't thinking about our skin while we're out there. We should be.

Basal cell carcinoma is the most common cancer in the world. About five million new cases in this country every year. Most of the time, it's slow growing and highly treatable. So people tend to wave it off. It's just basal cell. Nothing to worry about. But treatable and easy are not the same word. And just how easy it is depends entirely on who you are.

Today we have four people. A doctor building something new — a patch that could change how this cancer gets treated. A woman who found her own cancer before her dermatologist did — she also happens to be my mother. A man who chose a completely different treatment — radiation instead of surgery — because he was afraid of what a scalpel would do to his face. And a woman who has had, by her own count, around a thousand of these cancers, who is also the mother of two children who inherited the very same thing, and who leads the Gorlin Syndrome Alliance.

Now let's start where this cancer starts. Small.

The mirror

Terry: When we say skin cancer, what are we actually talking about — and where does basal cell fit?

Dr. Bokhari: Basal cell carcinoma is the most common skin cancer, largely catalyzed by exposure to sunlight and ultraviolet radiation. The only good thing is, it is a slow-growing cancer.

Terry: Slow growing. Now that's why so many people catch it early — sometimes before a doctor does. And here's one of them.

Kay: Fifteen, twenty years almost, I've been going in to the dermatologist about every six months. And then I discovered this little pinpoint place, right on the right side of my nose.

Terry: A little red dot. Not a scan, not a specialist — her own eyes, on her own face. Hold on to that. It's the cheapest, most powerful tool in this whole episode. But catching it is only the beginning. Then comes the wait.

The knife

Terry: The standard treatment is a procedure called Mohs surgery. Here's what it involves, from someone who's been through it more than once.

Kay: They'll cut away a portion of it, and then you go sit and wait while the borders are checked — to see if perchance they got all of the lesion. And then if they didn't, you have to go back again.

Terry: Cut, wait, check, repeat. It works. But it takes time and a trained surgeon, and there aren't enough of them. Right now there's a backlog of roughly seven million patients waiting for Mohs — and the line is getting longer.

Kay: It wasn't like now, where you might have to wait two months to get in, or more than that. It was scheduled probably within the next week or so.

Terry: That was twelve years ago — within a week. Today, that same appointment can be two months out. The cancer didn't get faster. The line got longer.

And Mohs isn't the only option. When Mark's second basal cell showed up — this time on his nose — he couldn't stop thinking about how much tissue they'd taken off his cheek the first time.

Mark: I just thought — because I know how much tissue they took off my left cheek — Lord, if they have to take that much off my nose, it'd be disfiguring.

Terry: So he did his own homework. An ad on his phone led him to something called superficial radiation therapy — SRT — and he chose it, to save his face.

Mark: I took twenty radiation treatments. Each dose was twenty seconds — Monday, Tuesday, and Wednesday, three days a week, until I finished. There was absolutely no scarring.

Terry: No scar. But look at what it asked of him: twenty separate trips to a radiation suite. One path makes you wait two months for surgery. The other saves your face but claims twenty appointments. Either way, you're choosing between your face or your time.

My mother — who you heard at the top of the show — her basal cell was on her nose, too. She has a small piece of it missing. That's the exact fear that sent Mark the other way. Which is the gap Dr. Bokhari is trying to close.

The patch

Terry: So what if you didn't always need the operating room — or the radiation suite? Dr. Raza Bokhari is a Philadelphia physician and biotech entrepreneur, and the Executive Chairman and CEO of Medicus Pharma. Their lead product is called SkinJect: a dissolvable patch about the size of a postage stamp.

Dr. Bokhari: SkinJect is our lead asset — a localized, precision-guided immunotherapy with no systemic or body circulation of the delivery of the drug.

Terry: Four hundred microscopic needles, each tipped with a tiny dose of a chemotherapy drug doctors have trusted for decades — delivered only where the cancer is, nowhere else. But the real design isn't the needles. It's the calendar. Listen to him walk it.

Dr. Bokhari: If it is diagnosed today, a Mohs procedure usually is scheduled 10 to 14 weeks later. Our patch, while you are waiting for your Mohs surgery, can be applied starting on day one — today — in a 30-minute office sitting. Come back on day seven and day 14, and then return for a visual inspection on day 57, or six weeks later. And if the lesion has disappeared, the patient doesn't need to continue and get more surgery done.

Terry: Three visits. Ninety minutes of your life, total — while you were going to be waiting anyway. And if it works, the surgery you spent months waiting for becomes a surgery you no longer need. And if it doesn't, your Mohs date is still there. You've lost nothing but a patch. Here's what it's done so far, in his words.

Dr. Bokhari: We have demonstrated that three out of four patients get visually cleared. They start off with the lesion, and after this patch application over two weeks in three sittings, a visual examination six weeks later shows that the lesion has disappeared.

Terry: Three out of four, visually cleared. And now the honest asterisk — because this show deals with the whole truth. To approve a cancer treatment, the FDA doesn't just look at the surface. It requires proof under the microscope that every cancer cell is gone. And on that deeper measure, the patch is at forty percent — and the bar the FDA will set is more than fifty. Dr. Bokhari believes they're in striking distance, and the next, larger study is designed to close that gap.

So let me say the most important part just as plainly. This patch is not FDA approved. It is investigational. Nobody can walk into a dermatologist's office and ask for it today. And it's possible the numbers never get there. The company sits down with the FDA later this summer to find out what the final study must look like. For most patients, the target is commercial availability in 2028 or 2029, if everything holds.

But look at what's at stake in the meantime. Only about a million Mohs procedures can be performed in this country each year — against five million new cases. An uncomplicated Mohs runs three to four thousand dollars. The patch is being aimed at around a thousand. And when I described it to Mark — a man who's been under the knife once already — here's what he said, unprompted.

Mark: You telling me there's a possible alternative with a patch — I would not be opposed to trying something like that before they actually would have to lay a knife to me. I would opt for the alternative.

Terry: Before they have to lay a knife to me. For Mark, this patch would be the better option. For the woman you're about to meet, it might be the only one.

The thousand

Terry: Everything you've heard so far is basal cell the way five million Americans a year get it. A spot, a surgery, a scar — a story with an ending. Julie Breneiser has been living with this cancer since before some of you were born, and her story doesn't have one. At least not yet.

Julie: Gorlin syndrome is a rare genetic disorder, and the most burdensome manifestation — many in our community have thousands in their lifetime. I've had probably around a thousand.

Terry: A thousand. She's a trained physician assistant. She helps lead the Gorlin Syndrome Alliance. And the disease didn't stop with her.

Julie: They were diagnosed at around age eight. And I was a physician assistant, so I thought I knew my stuff — but at the same time, I'm a patient and a human being first. The formal diagnosis for our daughter came when she was seven years old.

Terry: Her daughter. Her son. Seven and eight years old. Remember Mark's fear — one surgery, on one nose? Now run that fear across a childhood.

There's a ritual in cancer wards all over this country. When treatment ends, the patient rings a bell. It means: finished. It means: I got to the other side. Listen to what the bell sounds like to someone who will never ring it.

Julie: It's a huge elephant that never leaves the room. We can never ring the bell like people do at the end of chemo or radiation. As one doctor told me — you will never be cancer free. That's a big pill to swallow.

Terry: You will never be cancer free.

A few years ago, this community got the closest thing to mercy it had ever seen: a topical treatment. And think about where every story in this episode has started — in the mirror. For the people on that trial, the mirror finally showed them something new.

Julie: You don't know whether you're on the drug or not — but you do, when you see your basal cells going away.

Terry: Their skin was clearing. For the first time in their lives, their skin was clearing. Then the trial missed its target — the FDA's usual bar, fifty percent improvement. And it was over.

Julie: They went from having no BCCs on their face to skin cancer surgery after skin cancer surgery, every three to six months. It's a devastating loss. It's like you're reaching for the golden apple, and you take a bite — and then the apple's taken away from you. It's a big tease.

Terry: And listen to what the fifty percent bar sounds like from inside a body that's had a thousand of these.

Julie: In rare disease, a thirty percent reduction would be huge for us. I've had over a thousand. So if I knew that there was something out there that was going to allow me to only have to deal with seven hundred in my lifetime — that's a big difference.

Terry: Seven hundred instead of a thousand. The trial called that failure. She calls it three hundred surgeries she wouldn't need. Can you imagine? Three hundred surgeries she wouldn't need.

So — a community that's been burned twice. A patch that isn't approved, being tested on patients who don't have the disease. There is no reason those two stories should ever have met. And here's how they did.

The letter

Terry: The history of medicine turns, more often than you think, on a letter. A patient writes to a doctor. A mother writes to a company. Somebody refuses to wait quietly, and they put it in writing. In October 2025, Julie wrote one. She didn't have a lab, or a lobbyist, or a connection. She had LinkedIn.

Julie: I contacted Dr. Bokhari through LinkedIn — just sent him a letter saying, we're a community of people heavily burdened with basal cell carcinomas, we'd love to learn more about your SkinJect. And he responded, and we had a virtual meeting. And this was just in October of 2025.

Terry: We are a community heavily burdened. One sentence, from a woman who has had a thousand cancers, to a man testing a treatment on people who'd only ever had one or two — maybe a few more, but not a thousand. He answered. And when I asked him about it, he reached for an old line from science: chance favors the prepared mind. Here is that same October, from the other side of the letter.

Dr. Bokhari: As they say, chance favors the prepared mind. Our current studies actually do not have any Gorlin syndrome patients in the study. However, in the fall of last year, the Gorlin Syndrome Alliance approached us. We have submitted an orphan drug designation for Gorlin syndrome.

Terry: The patients found the treatment before the treatment found them. And because Gorlin is rare, it may move on a faster road.

Dr. Bokhari: Through an accelerated study that we are right now putting together, there is a possibility that this could become available perhaps in the next 12 to 14 months.

Terry: Maybe twelve to fourteen months — if the science holds, and if the FDA agrees. Still investigational. Still no guarantee. This community knows better than anyone that golden apples get taken away.

But two things are different this time. The FDA itself opened a new pathway this year for diseases exactly like this one — too rare for a standard trial — judging treatments on how they work and the safety data that exists, instead of demanding numbers a small community can't produce. The very trap that took the last treatment away is the one regulators are now trying to fix.

And the second thing: this community doesn't wait quietly anymore. They've been to the FDA. They put their burden on the record — including something you don't forget once you've seen it.

Julie: Ours include a photo gallery, with images of people of all ages with lots of basal cell carcinomas.

Terry: Faces of every age. So no one — no company, no regulator — can talk about endpoints without seeing who's on the other side of that number.

What you can do

Terry: So, what do you do with all this?

One: check your mirror. Every patient in this episode found their own cancer — a red dot, a spot that bleeds with no reason. If something on your skin doesn't go away in a few weeks, make the appointment. You are the cheapest early detection system there is.

Number two: wear sunscreen. Reapply it often. It is the least expensive cancer prevention you will ever buy.

Three: if Gorlin syndrome touches your family, find the Gorlin Syndrome Alliance at gorlinsyndrome.org — G-O-R-L-I-N syndrome dot org. You just heard what one message from that community set in motion. You should follow what they're doing.

Number four: watch the pipeline. Honestly, just watch the pipeline — innovation is amazing. The patch you heard about tonight is not approved. It may never be. But whether treatments like it live or die is decided by rules — endpoints, pathways, trial designs — and patients are finally in the room where those rules get written.

My thanks to Dr. Raza Bokhari, Kay Frazer, Mark Smith, and Julie Breneiser — for the science and the truth in the same hour. Two voices to take with you. The simplest advice in this episode —

Kay: Be very diligent about paying attention to your own body. And I'm the one that discovered it.

Terry: — and the reason all of it matters.

Julie: Nobody wants more scars. I think about my thirty-something kids and their scars, and wouldn't it be marvelous if the work they've had to have done could have been done with a topical treatment that didn't leave them with a scar on their nose, a scar on their temple?

Terry: Wouldn't that be marvelous. Julie — I'm hoping. I'm hoping.

If this episode meant something to you, follow State of the Patient wherever you're listening — Apple Podcasts, Spotify, YouTube, wherever you are. It's free, it takes one tap, and it's the single best way to make sure stories like these keep getting told. And if you know someone staring at a spot in the mirror — send them this one.

I'm Terry Wilcox. Until next time: wear your sunscreen, check your mirror, and take care of each other.

The State of the Patient Podcast is produced by Patients Rising. This transcript has been lightly edited for readability. Listen to the full episode and read the recap: [LINK].

Note: the SkinJect patch discussed in this episode is investigational and has not been approved by the FDA.