ReviewIntralesional agents in the management of cutaneous malignancy: A review
Section snippets
Basal cell carcinoma
BCC is the most common cancer of mankind, comprising over 80% of nonmelanoma skin cancer diagnoses.1, 2 Excision or curettage and electrodessication are often used for treatment of BCC, and are cost-effective with low rates of recurrence. Micrographic surgery claims the lowest recurrence rate, but it is labor-intensive, expensive, and sometimes, geographically restricted. Because surgical or destructive techniques estimate 5-year cure rates to be around 90% for primary BCC, this should be the
Squamous cell carcinoma
SCC is the second most common form of skin cancer in mankind. An estimated 250,000 cases occur annually in the United States, mostly on sun-exposed skin.28 Intralesional therapy focuses on invasive SCC, whereas intraepithelial processes, such as actinic keratosis or SCC in situ (Bowen disease), are more aptly treated with topical modalities.
Keratoacanthoma (KA) is an entity difficult to classify. Initially considered benign, but with a malignant appearance, the concept of KA has blurred, and
Primary cutaneous B-cell lymphomas
Intralesional therapy has been considered for 4 subgroups of primary cutaneous B-cell lymphoma (PCBCL): (1) primary cutaneous follicle-center lymphoma (PCFCL); (2) primary cutaneous marginal zone lymphoma (PCMZL); (3) primary cutaneous diffuse large B-cell lymphoma (PCLBCL), leg type; and (4) PCLBCL, other types.
Speaking generally, PCFCL and PCMZL are associated with an excellent prognosis and have been successfully managed using intralesional agents. PCLBCL leg type maintains a less favorable
CD30+ lymphoproliferative disorders
CD30+ cutaneous lymphoma is the second most common form of cutaneous T-cell lymphoma, superseded only by classic mycosis fungoides. Indeed, over the last several decades, dermatology has recognized a spectrum of disease ranging from lymphomatoid papulosis (classically a “benign” CD30+ disorder) to frank primary cutaneous anaplastic large cell lymphoma (PCALCL). Even for PCALCL, the overall prognosis is generally excellent, with 5-year survival exceeding 90%. Although data are limited to case
Metastatic melanoma
Because depth of invasion is the single most important prognostic factor in melanoma, it would be imprudent to advocate intralesional therapy of a primary melanoma under anything other than the most extraordinary of circumstances. Nevertheless, some investigators have explored the idea of using intralesional agents for control and palliation of metastatic melanoma.
Historically, antiblastics and dinitrochlorobenzene have been used for intralesional management based on strong cytolytic properties.
Conclusion
In sum, a variety of intralesional agents exist to treat common skin malignancies, including: BCC, SCC, some forms of PCBCL and CD30+ T-cell lymphoproliferative disorders, and cutaneous and subcutaneous melanoma metastasis. The intralesional therapies most often used can be seen in Table II. Their costs can be compared in Table III.
Admittedly, management of cutaneous malignancy through the administration of intralesional agents has not been as widely integrated into clinical practice as have
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Dissolvable microneedle particles for enhanced topical drug delivery
2024, Journal of Drug Delivery Science and TechnologyChemotherapeutical treatment of basal cell carcinoma with bleomycin via microinfusion of the drug into the skin (MMP®)
2023, Anais Brasileiros de DermatologiaSuccessful treatment of squamous cell carcinoma with intralesional methotrexate
2022, JAAD Case ReportsCitation Excerpt :The treatments combining surgery with radiotherapy or chemotherapy showed efficiency only in early-stage and well-defined cSCC.8 Intralesional 5-fluorouracil, interferon α, and methotrexate have been used sporadically for the treatment of squamous cell carcinoma.9 A 90-year-old man from Morelia, México, with no significant medical history presented in June 2017 with a 2-cm tumor on the right side of the lower vermilion, extending about 5 mm inside of the oral mucosa.
Triple therapy with intralesional 5-fluorouracil, chemowraps, and acitretin: A well-tolerated option for treatment of widespread cutaneous squamous cell carcinomas on the legs
2019, JAAD Case ReportsCitation Excerpt :The first case noted significant improvement only after acitretin was started, suggesting a synergistic benefit of combining acitretin with intralesional 5-FU and chemowraps. Intralesional 5-FU and chemowraps have been used for SCC treatment2,3 and acitretin for prevention.4 A PubMed search from 1970 until April 2019 using various combinations of the terms acitretin or retinoid and fluorouracil or chemotherapy and leg or extremity finds that their combination has never been reported as a therapeutic option for SCCs.
Clinical Efficacy of 5-Fluorouracil and Bleomycin in Dermatology
2024, Journal of Clinical Medicine
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