Review
Intralesional chemotherapy for nonmelanoma skin cancer: A practical review

Presented as a poster at the Annual Meeting of the American Society for Dermatologic Surgery, Orlando, FL, November 8, 2008.
https://doi.org/10.1016/j.jaad.2009.09.048Get rights and content

Intralesional chemotherapy for nonmelanoma skin cancer has existed for more than 5 decades. However, it is used so infrequently that recent consensus guidelines for the treatment of basal cell and squamous cell carcinoma do not include intralesional chemotherapy. Barriers to the use of intralesional chemotherapy include the off-label use of these agents, absence of therapeutic guidelines, a relatively small number of patients treated, and a lack of large, well-designed trials with long-term follow-up. Surgical intervention remains the gold standard for the treatment of nonmelanoma skin cancer; however, intralesional chemotherapy remains an option for well-selected patients who cannot or will not undergo surgery. The objectives of this article are to determine response rates and suggest reasonable treatment guidelines for the treatment of squamous cell carcinoma, keratoacanthoma, and basal cell carcinoma with the most widely available intralesional agents (methotrexate, 5-fluorouracil, bleomycin, and interferon).

Section snippets

Methods

A search of the MEDLINE database (1950-present) was conducted to identify original studies evaluating intralesional chemotherapy agents as the main therapy of nonmelanoma skin cancer (NMSC). The terms “squamous cell carcinoma,” “basal cell carcinoma,” “keratoacanthoma,” “fluorouracil,” “methotrexate,” “bleomycin,” and “interferon” were used in combination. Additional primary sources were identified in the reference lists of articles identified by the MEDLINE search. More than 2500 articles were

Results

Of the 56 articles included in our review, 51 of the sources were case reports, case series, or open-label studies. Four were prospective, dose-comparison studies and one was a randomized, placebo-controlled trial. Table I, Table II, Table III, Table IV organize these references and data according to the intralesional agent.

Discussion

Surgery remains the mainstay of treatment of invasive SCC and some BCC. For high-risk tumors, Mohs micrographic surgery is the standard of care, because of its consistently superior cure rates. In select circumstances, for example when excisional modalities have repeatedly failed or are not possible, the treatment of tumors with intralesional chemotherapy may be a reasonable option (Table VI). The lack of well-designed trials or guidelines for the use of intralesional chemotherapy leaves the

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    Funding sources: None.

    Conflicts of interest: None declared.

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