Treatment of a giant squamous cell carcinoma on the dominant thumb with intralesional 5-fluorouracil

Intralesional Treatments for Invasive Cutaneous Squamous Cell Carcinoma

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.

Debulking followed by intralesional 5-fluorouracil for the treatment of cutaneous squamous cell carcinoma and keratoacanthoma: A retrospective analysis

Debulking followed by intralesional 5-fluorouracil (deb-IL5FU) is a nonsurgical modality which has been used to treat skin cancer anecdotally for many years. There are few in depth studies examining this technique and success rate of intralesional 5-fluorouracil (IL5FU) for the treatment of cutaneous squamous cell carcinoma (cSCC). To evaluate the response rate of deb-IL5FU for the treatment of cSCC and to determine which patient factors were associated with tumor clearance or treatment failure. A retrospective chart analysis of patients with the diagnosis of cSCC or keratoacanthoma (KA) and subsequent deb-IL5FU treatment. Sixty-one patients with a total of 315 tumors (cSCC and KA), were treated using deb-IL5FU. The overall tumor clearance rate was 89%. This was highest for well-differentiated SCC, SCC, KA-type SCC, and KA. Tumors on the trunk and extremities showed high clearance rates while tumors on the scalp/face/neck/ears showed lower clearance rates. Immunocompetent patients cleared more tumors compared to immunocompromised patients. Limitations included the retrospective nature of this analysis as well as a small sample size. Treatment of cSCC and KA with deb-IL5FU demonstrated high tumor clearance rates. Lower rates of clearance were seen in males, immunosuppressed patients, tumors located on the scalp and face/neck/ears.

Field cancerization: Treatment

The goal of field cancerization treatment is to reduce the risk of developing keratinocyte carcinoma. Selecting the appropriate therapy depends on the degree of field cancerization and the number of invasive cutaneous squamous cell carcinomas. Other considerations include treatment efficacy, cost, side effects, and patient preference. Field therapies are preferred because they address clinically visible disease and subclinical atypia. However, lesion-directed therapies are useful for lesions that are more difficult to treat or those where a histologic diagnosis is required. Patients with extensive field cancerization benefit from a combination of field-directed and lesion-directed treatments. The second article in this continuing medical education series provides a framework to guide evidence-based decision making for field cancerization treatment.

A patient with squamous cell carcinoma in-situ successfully treated with intralesional 5-Fluorouracil and topical trichloroacetic acid

Background: The current gold standard and the first line of treatment for non-melanoma skin cancer is surgical excision. Nevertheless, some patients are not good candidates for surgery when wound healing may be impaired.Methods: A 96-year-old male presented with 1.2 cm by 1.5 cm tumoral lesion with an ill-infiltrated border and central ulceration located on the mid right lower leg. Biopsy confirmed the diagnosis of squamous cell carcinoma (SCC) in situ. The primary lesion was treated centrally to peripherally with multiple intralesional injections of 1.5 mL 5-Fluorouracil (5-FU) (50 mg/mL). The lesion was also treated with a single layer application of 80% Trichloroacetic acid (topical solution). One additional and final treatment of only 80% TCA was performed after three weeks.Results: There was a complete regression of the SCC three weeks after the second treatment.Conclusions: We demonstrate a case of SCC successfully treated with intralesional 5-FU and topical Trichloroacetic acid. Additionally, the SCC in situ was successfully cleared in two treatment sessions with the lowest cumulative dose of 5-FU reported. Intralesional injections of 5-FU and subsequent topical Trichloroacetic acid may be an effective option for patients with SCC who are not eligible for cutaneous surgery.

Intralesional 5-fluorouracil (FU) as a treatment for nonmelanoma skin cancer (NMSC): A review

The treatment paradigm for nonmelanoma skin cancer remains surgical. This fact combined with its remarkably high incidence positions it as the fifth most costly cancer to treat in the Medicare population. To address this, consideration of alternative medical therapeutics is warranted. Intralesional 5-fluorouracil is a potentially affordable option that may demand further investigation. This literature review examines current data on its efficacy and adverse effects.