ABSTRACT
BACKGROUND: Treatment strategies for cutaneous squamous cell carcinoma in situ (cSCCIS) are many but reported cure rates are variable and few studies report 5-year follow-up data. OBJECTIVE: To evaluate the treatment of cSCCIS by curettage followed by topical imiquimod 5% cream (C&I). METHODS: We evaluated all immunocompetent patients with biopsy proven cSCCIS treated by C&I between January 2008 and December 2012. RESULTS: A total of 861 patients with 1,198 cSCCIS were treated, with median follow-up of 71 months. The mean tumor diameter was 10.2 mm. The average duration of treatment with imiquimod 5% cream was 21 days. Kaplan-Meier estimated recurrence-free survival at 5-year follow-up was 99.71% with 95% CI (99.38%, 100.00%). A follow-up questionnaire returned by 45% of patients revealed that 94% were satisfied with their treatment. Six hundred eleven patients developed a new nonmelanoma skin cancer (NMSC) during the follow-up period, and 91% (556/611) of patients chose this combination treatment for at least one new NMSC. CONCLUSION: The combination treatment for cSCCIS of C&I had less than 1% cumulative probability of treatment failure at 5 years. Patients tolerated the treatment well, with the majority choosing this method of treatment for at least one new NMSC.
Subject(s)
Carcinoma, Squamous Cell/drug therapy , Carcinoma, Squamous Cell/surgery , Curettage , Imiquimod/administration & dosage , Skin Neoplasms/drug therapy , Skin Neoplasms/surgery , Administration, Cutaneous , Adult , Aged , Aged, 80 and over , Antineoplastic Agents/administration & dosage , Combined Modality Therapy , Female , Humans , Male , Middle Aged , Surveys and QuestionnairesABSTRACT
BACKGROUND: Most actinic keratoses (AKs) respond to standard treatments, but a subset persist and require further intervention. We report a series of 10 patients with AKs that failed to respond to conventional treatment with cryotherapy and topical monotherapy but responded completely to simultaneous therapy with topical 5-fluorouracil (5-FU) and imiquimod creams. OBJECTIVE: To report the success of this combination therapy in refractory AKs and to determine whether any clinical or histologic features predict for treatment resistance. METHODS: Case-control study with two control groups matched to each patient according to lesion location and sex. RESULTS: Mean lesion diameter (p < .001), lesion diameter greater than 1 cm (p < .001), and the presence of pain (p = .01) were statistically associated with failure of cryotherapy and topical monotherapy. None of the histologic features evaluated were found to be statistically significant, although thicker epidermis was nearly so (p = .054). CONCLUSIONS: In patients who have failed standard therapy for AKs, combination treatment using topical 5-FU and imiquimod cream may be an effective alternative therapeutic strategy. Larger lesion diameter, specifically greater than 1 cm, and the presence of pain predict conventional treatment resistance.
Subject(s)
Aminoquinolines/therapeutic use , Antineoplastic Agents/therapeutic use , Fluorouracil/therapeutic use , Keratosis, Actinic/drug therapy , Keratosis, Actinic/pathology , Aged , Aged, 80 and over , Analysis of Variance , Antimetabolites, Antineoplastic/therapeutic use , Case-Control Studies , Chi-Square Distribution , Cryosurgery , Drug Therapy, Combination , Female , Humans , Imiquimod , Keratosis, Actinic/surgery , Male , Middle Aged , Retrospective Studies , Treatment FailureABSTRACT
A woman had cutaneous, mucosal, and possible visceral leishmaniasis simultaneously. Many of her cutaneous lesions consisted of boggy indurations rather than customary papules, nodules, or ulcers. This unusual case was finally cured after four courses of miltefosine, one course of antimony, and two courses of Ambisome.
Subject(s)
Amphotericin B/therapeutic use , Antiprotozoal Agents/therapeutic use , Leishmaniasis, Cutaneous/pathology , Phosphorylcholine/analogs & derivatives , Antimony/therapeutic use , Biopsy , Bolivia , Drug Therapy, Combination , Female , Humans , Middle Aged , Phosphorylcholine/therapeutic use , Travel , Treatment OutcomeSubject(s)
Adenolymphoma/pathology , Skin Neoplasms/pathology , Thigh , Aged , Dermis/pathology , Female , Humans , Lymphocytes/pathology , Subcutaneous Fat/pathologySubject(s)
Adrenergic alpha-1 Receptor Agonists , Adrenergic alpha-Agonists/therapeutic use , Erythema/drug therapy , Flushing/drug therapy , Oxymetazoline/therapeutic use , Rosacea/complications , Aged , Erythema/etiology , Erythema/pathology , Female , Flushing/etiology , Humans , Male , Middle Aged , Patient Satisfaction , Telangiectasis/drug therapy , Telangiectasis/etiology , Treatment OutcomeABSTRACT
Topical therapeutic options for cutaneous squamous cell carcinoma in situ include 5-fluorouracil cream and imiquimod cream. Such treatment may be preferable to surgical or destructive modalities in certain anatomic locations and in instances where patients are unwilling or poor surgical candidates. We present 4 such patients with cutaneous squamous cell carcinoma in situ involving a digit. Each patient failed treatment with imiquimod cream as monotherapy. In addition, two patients failed treatment with 5-fluorouracil cream as monotherapy. All 4 responded completely to 5-fluorouracil and imiquimod cream as combination therapy. In patients who have failed monotherapy with a topical agent for cutaneous squamous cell carcinoma in situ, combination treatment using both topical 5-fluorouracil cream and imiquimod cream may be considered as an alternative therapeutic strategy.
