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Intralesional 5-Fluorouracil for Treatment of Non-Melanoma Skin Cancer
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This systematic review included 19 studies and evaluated the use of intralesional fluorouracil (IL 5-FU) for the treatment of non-melanoma skin cancer (NMSC). Of the 283 patients treated with IL 5-FU, 66 were treated for squamous cell carcinoma (SCC), 128 were treated for basal cell carcinoma (BCC), and 89 were treated for keratoacanthoma (KA). SCCs cleared after an average of 9.6 weeks with a mean clearance rate of 87%. It took an average of 12 weeks for BCCs to clear with a mean clearance rate of 91.4%. KAs took an average of 7.3 weeks to resolve with a 74.5% average clearance rate. Although there was no significant difference in the clearance rate between SCC and BCC after IL 5-FU treatment (87% vs 91.4%; P = .2), the clearance rate for SCC and BCC was greater than the clearance rate for KA (74.5%; P < .007). Lesion durations prior to IL 5-FU and time to resolution after IL 5-FU treatment were not statistically different among these types of NMSC (P > .3).
- These findings suggest IL 5-FU was associated with a higher clearance rate for SCC and BCC as compared with KA. However, this nonsurgical treatment option could be beneficial in certain populations such as patients with multiple prior tumors refractory to standard treatments, those with multiple other comorbidities, and lesions in cosmetically sensitive locations. Additional clinical studies directed at understanding the safety and efficacy of IL 5-FU for treatment of NMSC are needed.
abstract
This abstract is available on the publisher's site.
Access this abstract nowBackground
Surgical excision is the paradigm treatment option for non-melanoma skin cancer (NMSC), however intralesional fluorouracil (IL 5-FU) is an efficacious alternative and superior to other chemotherapy agents in NMSC. Yet, little summative data exists on the topic.
Objective
To assess the efficacy of IL 5-FU in the treatment of NMSC.
Methods and Materials
A systematic review was performed using PubMed, Embase and Web of Science databases. 19 studies were included. ANOVA test was used to compare the duration of lesion prior to therapy and resolution time following IL 5-FU treatment. A two-way proportion test was performed to compare the clearance rate between squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and keratoacanthoma (KA).
Results
There was no significant difference between the clearance rate of SCC and BCC after IL 5-FU therapy (87 % vs 91.4%, respectively; P=0.2); however, the clearance rate of both SCC and BCC was significantly greater than that of KA (74.5%; P<0.007); 95% CI [2.56%–19.1%]. Lesion duration and resolution time did not significantly differ across SCC, BCC, and KA (P>0.3).
Conclusion
While majority of data is derived from individual cases, IL 5-FU achieved higher clearance rate in SCC and BCC groups than in KA group.
Additional Info
Disclosure statements are available on the authors' profiles:
Dermatology
This is a well-done systematic review evaluating the use of intralesional 5-fluorouracil for the treatment of squamous cell carcinoma (SCC), basal cell carcinoma (BCC), and keratoacanthoma (KA). Maghfour et al found that the use of intralesional 5-fluorouracil lead to a clearance rate of 87% in SCC, 91.4% in BCC, and 74.5% in KA, with an average resolution time of 9.6 weeks for SCC, 12 weeks for BCC, and 7.3 weeks for KA. This article highlights the use of intralesional 5-fluorouracil as an effective option for treating certain forms of nonmelanoma skin cancer (NMSC), which can be particularly useful in patients with multiple eruptive small SCCs and/or KAs, particularly on the lower extremities. It should be highlighted that, if clearance does not occur particularly in SCCs, that unattended growth could eventually lead to a carcinoma-associated life-threatening situation. Thus, when intralesional 5-fluorouracil is employed as a therapeutic option, close follow-up is a necessity to monitor for recurrence or non-clearing tumors, which should then prompt a more aggressive surgical curative approach.