Chemowraps as an Adjuvant to Surgery for Patients With Diffuse Squamous Cell Carcinoma of the Extremities

Background: Managing patients with diffuse squamous cell carcinoma (SCC) and actinic damage on their extremities is challenging because SCCs may be ill-defined, confluent, and only amenable to radical surgery. Diffuse actinic keratoses put patients at risk for further malignancies and may be difficult to distinguish from SCCs. An experience using chemowraps, a novel approach involving weekly 5-fluorouracil (5-FU) 5% cream under Unna wraps to reduce actinic keratoses, as an adjuvant to surgery is described.

Methods: A series of 3 representative patients is presented. Before chemowraps were applied, biopsies and clinical lymph node examinations were performed to confirm the diagnosis of SCC. Patients were informed that chemowraps represent an off-label use of 5-FU to reduce actinic keratoses as an adjuvant to definitive surgery for SCCs.

Results: Three patients were referred for diffuse actinic damage and biopsy-proven SCCs on the legs. Patients tolerated chemowraps well (applied for 4-20 weeks) and showed reduction in clinical lesions at 6 weeks to 3 years follow-up.

Conclusions: Chemowraps may be useful in managing patients with diffuse SCCs in fields of severe actinic damage on the extremities. As an adjuvant to surgery, chemowraps may treat surrounding actinic keratoses, help define tumor borders, and minimize the extent of surgery required.