Quimioterapia Topica

 Published in Dermatology

Journal Scan / Case Study · February 13, 2020

Combination Topical Chemotherapy for the Treatment of an Invasive Cutaneous Squamous Cell Carcinoma

Journal of Drugs in Dermatology

TAKE-HOME MESSAGE

• An 86-year-old man with biopsy-proven invasive squamous cell carcinoma (SCC) who refused surgical management was treated with a combination of topical imiquimod 5% cream, 5-FU 2% solution, and tretinoin 0.1% cream under occlusion for 5 nights each week for a total of 24 applications. Additionally, cryotherapy was used every 2 weeks during treatment. Despite discontinuing treatment earlier than the goal of 30 topical applications due to burning pain, a repeat biopsy 15 months after completing this nonsurgical regimen showed only scar with no residual carcinoma.

• Topical combination therapy may be a treatment option in a subset of patients who are not candidates or decline surgery for small, invasive SCC.

– Caroline K. Crabtree, MD

Abstract

INTRODUCTION

Standard of care for squamous cell carcinoma (SCC) is usually surgical, with either excision or Mohs micrographic surgery. However, surgery may not be ideal for elderly patients with numerous lesions, who are poor surgical candidates or who refuse surgery. Topical 5-fluorouracil (5-FU) and imiquimod have been studied off-label as monotherapies in the treatment of SCC in situ with promising results. However, long-term tumor-free survival rates are still less than with surgical management.

METHODS

We report a case of biopsy-proven invasive SCC in an 86-year-old Caucasian male with history of multiple actinic keratoses and no previous skin cancers. The patient declined surgical treatment due to concerns about cosmetic outcomes. A combination of topical 5% imiquimod cream, 2% 5-FU solution, and 0.1% tretinoin cream was used five nights per week under occlusion for a treatment goal of 30 total applications. The patient was evaluated in clinic every 2 weeks during which the site was treated with cryotherapy. The patient reported burning pain associated with treatment and only completed 24 of the 30 applications.

RESULTS

Follow-up biopsy 15 months after completing topical treatment revealed dermal scar with no evidence of residual carcinoma.

CONCLUSION

Topical combination therapy with imiquimod, 5-FU, and tretinoin with intermittent, brief cryotherapy effectively treated a small, invasive SCC in this select patient who deferred surgery. Prospective randomized-controlled clinical trials to assess the role of combination topical treatment for invasive SCCs are warranted.

Journal of Drugs in Dermatology

Combination Topical Chemotherapy for the Treatment of an Invasive Cutaneous Squamous Cell Carcinoma

J Drugs Dermatol 2020 Feb 01;19(2)202, R Fayne, S Nanda, A Nichols, J Shen