1
|
Baeza-Hernández G, Cañueto J. Intralesional Treatments for Invasive Cutaneous Squamous Cell Carcinoma. Cancers (Basel) 2023; 16:158. [PMID: 38201585 PMCID: PMC10778043 DOI: 10.3390/cancers16010158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2023] [Revised: 12/18/2023] [Accepted: 12/21/2023] [Indexed: 01/12/2024] Open
Abstract
Cutaneous squamous cell carcinoma (cSCC) is the second most frequent cancer in humans and has the potential to progress locally, metastasize, and cause death in a subset of patients. cSCC is especially common in the elderly, and it will probably represent a major health concern in the near future. Surgery is the standard treatment for cSCC, but intralesional therapies can sometimes be considered for certain patients and under certain circumstances. The choice of intralesional treatment depends on the patient's characteristics and the clinician's previous experience and expertise. Here we are reviewing intralesional treatments for cSCC and keratoacanthoma (KA). We have started with some classic drugs, such as methotrexate and 5-fluorouracil, bleomycin, interferon, and cryosurgery, but also comment on electrochemotherapy. Finally, we have focused on novel therapies, some of which are under development, and future perspectives, including intralesional immunotherapy and oncolytic viruses.
Collapse
Affiliation(s)
- Gloria Baeza-Hernández
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
| | - Javier Cañueto
- Department of Dermatology, Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, 37007 Salamanca, Spain;
- Instituto de Biología Molecular y Celular del Cáncer (IBMCC), Centro de Investigación del Cáncer (CIC)-CSIC, Laboratory 20, 37008 Salamanca, Spain
- Instituto de Investigación Biomédica de Salamanca (IBSAL), Complejo Asistencial Universitario de Salamanca, Paseo San Vicente 58-182, Hospital Virgen de la Vega, 10ª Planta, 37007 Salamanca, Spain
| |
Collapse
|
2
|
Alghamdi NA, Taj MA, Alamri SA, Taj JA, Alshowaikhat SJ, Jaber T, Jadkarim G. Solitary Keratoacanthoma of the Scalp: A Case Report. Cureus 2023; 15:e51176. [PMID: 38283471 PMCID: PMC10816829 DOI: 10.7759/cureus.51176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/27/2023] [Indexed: 01/30/2024] Open
Abstract
Keratoacanthoma (KA) is a pruritic, rapidly growing cutaneous neoplasm originating from the infundibulum of the hair follicle on the sun-exposed area. Usually presents as a dome-shape with a centralized keratinous plug. Whether KA is benign or malignant is challenging due to its similarity to squamous cell carcinoma (SCC). In this case study, we present a 57-year-old patient who came to the surgery clinic with a rapidly growing ellipse-shaped nodule on her scalp for two years, which was diagnosed and treated as solitary KA by excisional biopsy. This case represents the first reported KA on the scalp of an elderly patient in Saudi Arabia.
Collapse
Affiliation(s)
- Norah A Alghamdi
- College of Medicine and Surgery, Batterjee Medical College, Jeddah, SAU
| | - Mashael A Taj
- Department of Medicine, King Faisal Hospital, Makkah, SAU
| | - Shuaa A Alamri
- Obstetrics and Gynecology, King Fahad Armed Hospital, Jeddah, SAU
| | - Jamal A Taj
- Orthopedic Surgery, College of Medicine, King Saud Bin Abdulaziz University for Health Sciences, Jeddah, SAU
| | | | - Tariq Jaber
- Bariatric, Minimal Invasive, and General Surgery, National Guard Health Affairs, Jeddah, SAU
| | - Galia Jadkarim
- Breast Oncoplasty, Endocrine, and General Surgery, National Guard Health Affairs, Jeddah, SAU
| |
Collapse
|
3
|
Seger EW, Tarantino IS, Neill BC, Wang T. Relative Efficacy of Nonoperative Treatment of Keratoacanthomas. J Cutan Med Surg 2019; 24:41-46. [DOI: 10.1177/1203475419882336] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Background Keratoacanthomas (KAs) are neoplasms of squamous epithelium which exhibit rapid growth and are often difficult to distinguish clinically from squamous cell carcinoma. Excision is the most common treatment, but in refractory cases or for KAs in cosmetically sensitive areas, nonoperative modalities may be better suited. Objective To compare efficacies of topical and intralesional therapies for the treatment of KAs. Methods A systematic literature review was performed using Medline, Ovid, and Embase. Studies looking at the efficacy of topical or intralesional treatments for KAs were included. To compare efficacy, 2-tailed t-tests were performed, with P < .05 considered statistically significant. Results Forty-one studies were identified across 5 modalities. Both topical and intralesional treatments had high KA eradication rates (92%-100%). Intralesional 5-fluorouracil led to faster KA healing times when compared to intralesional methotrexate (3.7 vs 4.6 weeks, P = .017). Similarly, topical 5-fluorouracil led to faster time to heal than topical imiquimod (3.8 vs 7.6 weeks with imiquimod, P < .0001). Conclusion For nonoperative treatment of KAs, strong evidence currently exists for both topical and intralesional therapies. Decisions on which modality to use should be made on a case-by-case basis.
Collapse
Affiliation(s)
- Edward W. Seger
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Isadore S. Tarantino
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Brett C. Neill
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Ting Wang
- Division of Dermatology, University of Kansas Medical Center, Kansas City, Kansas, USA
| |
Collapse
|
4
|
Scalvenzi M, Patrì A, Costa C, Megna M, Napolitano M, Fabbrocini G, Balato N. Intralesional Methotrexate for the Treatment of Keratoacanthoma: The Neapolitan Experience. Dermatol Ther (Heidelb) 2019; 9:369-372. [PMID: 30790234 PMCID: PMC6522596 DOI: 10.1007/s13555-019-0286-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Indexed: 12/02/2022] Open
Abstract
Introduction Keratoacanthomas are cutaneous neoplasms known for their rapid growth and spontaneous regression over a long time period. Their treatment can be difficult because of the potentially large field size and number of lesions. Intralesional methotrexate constitutes an effective, nonsurgical treatment of keratoacanthomas, as proven by our experience. Methods We treated 11 elderly patients affected by keratoacanthoma with intralesional methotrexate. The injections were performed weekly, followed by 10 mg of folic acid to be taken 24 h later. Results All our patients underwent complete resolution of the lesions after 4–8 injections, without side effects. Conclusion Intralesional methotrexate seems to be an effective and safe nonoperative treatment modality for keratoacanthoma, especially when it arises in anatomic areas difficult to treat with surgery, in elderly debilitated patients, and in those refusing surgery.
Collapse
Affiliation(s)
| | - Angela Patrì
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Claudia Costa
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Matteo Megna
- Department of Dermatology, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Department of Medicine and Health Sciences Vincenzo Tiberio, University of Molise, Campobasso, Italy
| | | | - Nicola Balato
- Department of Dermatology, University of Naples Federico II, Naples, Italy.
| |
Collapse
|
5
|
Alain J. Management of Keratoacanthoma. CURRENT DERMATOLOGY REPORTS 2012. [DOI: 10.1007/s13671-012-0010-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
|
6
|
Aubut N, Alain J, Claveau J. Intralesional Methotrexate Treatment for Keratoacanthoma Tumors: A Retrospective Case Series. J Cutan Med Surg 2012; 16:212-7. [DOI: 10.1177/120347541201600316] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Background: Intralesional methotrexate (IL-MTX) is an effective treatment for keratoacanthoma. Objective: We sought to determine the response rates and adverse events in KA treated with intralesional methotrexate. Methods: All cases of KA treated with intralesional methotrexate at our institutions from 2001 to 2009 were systematically reviewed. Results: Forty-six cases of KA treated with IL-MTX were identified. A complete resolution was achieved in 74% of patients, requiring an average of 1.8 injection sessions, for a mean total dose of 10 mg. Adverse events did not occur. Limitations: The follow-up period was short, and there was no histologic confirmation of the initial diagnosis. Conclusion: IL-MTX is an effective and well-tolerated alternative to surgery for the treatment of KA.
Collapse
Affiliation(s)
- Nicolas Aubut
- Department of Dermatology, Centre Hospitalier Universitaire de Québec, Hôtel-Dieu de Québec, Quebec City, QC
| | - Jimmy Alain
- Centre Dermatologique du Québec Métropolitain, Quebec City, QC
| | - Joël Claveau
- Clinique Dermatologique Joël Claveau, Quebec City, QC
| |
Collapse
|
7
|
Martorell-Calatayud A, Requena C, Nagore E, Sanmartín O, Serra-Guillén C, Botella-Estrada R, Sanz-Motilva V, Llombart B, Alcañiz-Moscardo A, Guillén-Barona C. Intralesional Infusion of Methotrexate as Neoadjuvant Therapy Improves the Cosmetic and Functional Results of Surgery to Treat Keratoacanthoma: Results of a Randomized Trial. ACTAS DERMO-SIFILIOGRAFICAS 2011. [DOI: 10.1016/j.adengl.2011.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
|
8
|
[Intralesional infusion of methotrexate as neoadjuvant therapy improves the cosmetic and functional results of surgery to treat keratoacanthoma: results of a randomized trial]. ACTAS DERMO-SIFILIOGRAFICAS 2011; 102:605-15. [PMID: 21742301 DOI: 10.1016/j.ad.2011.03.013] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2010] [Revised: 03/09/2011] [Accepted: 03/14/2011] [Indexed: 11/21/2022] Open
Abstract
BACKGROUND Keratoacanthoma is currently considered to be an in situ squamous cell carcinoma that mainly affects patients over 70 years of age. The tumor has a good prognosis and, in some cases, can resolve spontaneously. Treatment involves simple excision. However, since the tumors generally occur on the face or extremities and display rapid growth, aggressive surgery may be required and the cosmetic results may be poor. OBJECTIVE The primary study objective was assessment of the efficacy of presurgical intralesional methotrexate infiltration to reduce the size of the tumor and the corresponding surgical defect. MATERIAL AND METHODS A prospective, randomized study was undertaken in patients with a diagnosis of keratoacanthoma of at least 1.5 cm who were seen in our service between January 2009 and January 2010. Two groups were established: one receiving a single infiltration of methotrexate prior to surgery and another that did not receive methotrexate. RESULTS Of the 25 patients included in the study, 10 received neoadjuvant intralesional methotrexate (group A) and 15 underwent surgery without prior infiltration of methotrexate (group B). The patients in group A displayed a reduction of between 50% and 80% in the size of the lesion prior to surgery. No complications were observed either in relation to methotrexate infusion or surgery. In group B, only 1 patient had a slight reduction in the dimensions of the lesion prior to surgery. In the remaining cases, the lesions remained similar (4 cases, 26%) or had increased in size (10 cases, 66%) at the time of surgery. Five patients in this group required hospital admission following surgery. CONCLUSIONS Neoadjuvant intralesional methotrexate is well tolerated and reduces the need for aggressive surgery in elderly patients with keratoacanthoma measuring more than 1.5 cm on the face or extremities.
Collapse
|
9
|
Annest NM, VanBeek MJ, Arpey CJ, Whitaker DC. Intralesional methotrexate treatment for keratoacanthoma tumors: a retrospective study and review of the literature. J Am Acad Dermatol 2007; 56:989-93. [PMID: 17504715 DOI: 10.1016/j.jaad.2006.12.017] [Citation(s) in RCA: 72] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2006] [Revised: 12/13/2006] [Accepted: 12/24/2006] [Indexed: 02/08/2023]
Abstract
BACKGROUND Intralesional methotrexate (MTX) is an effective treatment for keratoacanthoma (KA). OBJECTIVE We sought to systematically examine response rates and adverse events in KA treated with intralesional MTX. METHODS All cases of KA treated with intralesional MTX at our institution from 1991 to 2006 were identified. A MEDLINE and PubMed search of cases of KA treated with intralesional MTX was also performed. RESULTS In all, 38 cases of KA treated with intralesional MTX were identified: 18 from our institution and 20 from the literature. Intralesional MTX achieved resolution in 92%, requiring an average of 2.1 injections an average of 18 days apart. Adverse events were rare, with two reports of pancytopenia in patients with chronic renal failure. LIMITATIONS Use of single case reports, small series, and retrospective analysis are limitations. CONCLUSION Intralesional MTX is a useful nonsurgical therapy for the treatment of KA. Histologic diagnosis before initiation of treatment is preferred. A complete blood cell count at baseline and during treatment should be considered to monitor for potential cytopenia.
Collapse
Affiliation(s)
- Nicole M Annest
- Division of Mohs Surgery, Scripps Clinic and Research Institute, La Jolla, California 92037, USA.
| | | | | | | |
Collapse
|
10
|
Abstract
BACKGROUND Keratoacanthoma (KA) is an extraordinary entity. Once considered a benign neoplasm that resembled a highly malignant one (pseudomalignancy), it is now viewed in an opposite light as a cancer that resembles a benign neoplasm (pseudobenignity). OBJECTIVE The goal was to delineate the malignant potential of this neoplasm based on the author's experience and a review of recent data and research and to emphasize the KA as a possible part of an autosomal dominant familial cancer syndrome, the Muir-Torre syndrome. METHODS This is a review of the literature. RESULTS In this work, the KA is reviewed with recent advances emphasized. CONCLUSION KA is an abortive malignancy that rarely progresses into an invasive SCC. The KA may serve as a marker for the important autosomal dominant familial cancer syndrome, the Muir-Torre syndrome, as a result of a defective DNA mismatch repair gene.
Collapse
|
11
|
|