Intralesional 5-Fluorouracil in the Treatment of Lower Leg Squamous Cell Carcinoma
November 2018 | Volume 17 | Issue 11 | Feature | 1241 | Copyright © 2018
Morgan Mackey DO,a Adam Shahsavari DO,b V. Thomas Mackey DOa
aAdvanced Desert Dermatology, Peoria, AZ and the Osteopathic Postdoctoral Training Institution (OPTI) at Midwestern University, Glendale, AZ bLarkin Palm Springs Community Hospital, Hialeah, FL
Non-melanoma skin cancer (NMSC) is the most commonly diagnosed cancer in the United States.1,2 There are different treatment modalities for non-melanoma skin cancer, that include surgical excision, radiation therapy, cryotherapy, electrodessication and curettage, photodynamic therapy, and topical chemotherapy. Intralesional injection with 5-fluorouracil is a treatment modality that is not used often, perhaps due to not much research available to its effectiveness or established treatment recommendations. We report a case of a patient with multiple lesions of cutaneous squamous cell carcinoma on the lower extremities treated successfully with intralesional 5- fluorouracil. J Drugs Dermatol. 2018;17(11):1241-1243.
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Non-melanoma skin cancer (NMSC) is the most commonly diagnosed cancer in the United States.1,2 While the prevalence of NMSC is continually elevating the overall treatment of choice remains to be surgical intervention. Surgical operations comprised over 95% of all basal cell carcinoma treatments within the United States.3 While this treatment style remains a staple to NMSC treatment it is not feasible in all situations due to wound closure issues, graft rejection, increased lesion size, or poor perfusion at the treatment site.4 In a patient whose clinical picture contains multiple aforementioned criteria, a less invasive treatment method is more likely to lead toward a favorable outcome. Non-surgical options include photodynamic therapy, immunotherapy, topical chemotherapy, radiation therapy, and intralesional therapies. Intralesional therapies have been explored, which primarily include interferon, bleomycin, 5-fluorouracil, and methotrexate.5 We report a case of the use of intralesional 5-fluorouracil for treatment of squamous cell carcinoma of the lower extremities. Case Report An 86-year-old female presented with a past medical history significant for hyperlipidemia, hypertension, atrial fibrillation, transient ischemic attack, breast cancer, lung cancer, osteoporosis, joint replacement of the left hip, double mastectomy, previous ankle surgery requiring placement of metal plate, poor circulation of her lower extremities, previous cutaneous squamous cell carcinoma of the left lower leg, previous smoker, and multiple erythematous tender papules with hyperkeratotic scale distributed throughout her lower legs. Sites of these lesions include the right proximal lateral pretibial skin, right proximal pretibial skin, left lateral ankle, and right distal lateral pretibial skin (Figures 1 and 2). Patient had a total of six lesions biopsied, with five of these lesions diagnosed histologically as well-differentiated squamous cell carcinoma and the left lateral ankle lesion diagnosed histologically as atypical cystic squamous proliferation.The patient’s history is significant for a squamous cell carcinoma of the lower extremity in the past that was excised, and afterwards required multiple wound clinic treatments and took almost one year to heal. With six new SCC lesions of the lower extremities found, there was concern about the healing of each of these spots if they were to be treated with excision. Thus, treatment with intralesional 5-fluorouacil was chosen as biopsy would be done post treatment to show results of this treatment.Treatment was initiated with intralesional injections of 5-fluorouracil. 5-Fluorouracil was administered via a 50mg/mL solution for a total of 0.6 milliliters at each lesion. All six lesions received 30mg of fluorouracil per treatment for a total course of six treatments on a weekly basis. Post-treatment biopsies were taken from the lesions and revealed complete resolution of squamous cell carcinoma at all treatment sites (Figure 3). Patient has been followed for 3 months after finishing treatment and has had no recurrence seen on exam. Patient reported no fatigue, diarrhea, mouth sores, eye irritation, headache, poor appetite, or other systemic side effects associated with the treatment of 5-fluorouracil.