Cryosurgery and 5-Fluorouracil Combination Therapy for Treatment of Bowen’s Disease and Superficial Basal Cell Carcinoma

December 2023 | Volume 22 | Issue 12 | 1166 | Copyright © December 2023


Published online November 29, 2023

doi:10.36849/JDD.7378

Samina Nazarali MDa, Dusan Sajic MD PhDb,c

aDepartment of Medicine, Dalhousie University, Halifax, NS, Canada
bGuelph Dermatology Research, Guelph, ON, Canada
cFaculty of Health Sciences, McMaster University, Waterloo, ON, Canada

Abstract
Background: Non-melanoma skin cancer (NMSC), which includes both Bowen's disease (BD) and superficial basal cell carcinoma (sBCC), is the most commonly diagnosed cancer in Canada. BD and sBCC are amenable to minimally invasive treatments however, large-scale studies assessing long-term outcomes are lacking, particularly regarding the timing and duration of non-invasive combination treatments.
Objective: Examine the clinical cure rate of BD and sBCC using a combination treatment consisting of a single cycle of cryotherapy followed by a three to four-week course of topical 5-fluorouracil (5-FU).
Methods: Retrospective chart review at a single center. Inclusion criteria included histology-proven sBCC or BD treated with either a combination protocol, cryosurgery, or 5-FU alone.
Results: 310 biopsy-confirmed cases of BD and 176 biopsy-confirmed cases of sBCC were analyzed. Of these, 229 cases of BD and 61 cases of sBCC were treated with cryosurgery and immediate 5-FU application, yielding a clearance rate of 90% and 86.9% at 6 months from initial treatment.
Conclusion: Cryosurgery followed by immediate 5-FU use may be an effective mode of treatment for BD and sBCC, negating the need for invasive procedures and allowing for increased accessibility. Further studies with longer follow-up intervals, comparisons with other non-invasive treatments, and evidence of histologic cure are required.

J Drugs Dermatol. 2023;22(12):1166-1171. doi:10.36849/JDD.7378

INTRODUCTION

Non-melanoma skin cancer (NMSC) is the most commonly diagnosed cancer in Canada with incidence rates continuing to rise.1-3 Basal cell carcinoma is the most common of these skin cancers, with superficial basal cell carcinoma (sBCC) making up between 10-17% of all basal cell cancers. Squamous cell carcinoma (SCC) is the second most common cutaneous neoplasm, with in situ SCC, referred to as Bowen's disease (BD), accounting for close to 12% of all SCCs.4 Collectively, sBCC and BD represent a substantial percentage of malignant cutaneous neoplasms in Canada and although morbidity secondary to NMSC is uncommon, leaving it untreated can result in significant disfigurement, functional impairment, and progression to SCC that may lead to distant metastases.5

Superficial basal cell carcinoma is confined to or is contiguous with the epidermis, and similarly, BD does not invade the underlying dermal layer.4 Thus, there is a question as to whether surgical interventions are required for treatment given the more invasive nature of the procedure, longer wait and recovery times, risk of associated morbidities, and aesthetic appearance of the final scar site.6 As the incidence of NMSC continues to rise, with rates expected to triple by 2031,1 there remains a need to evaluate less invasive treatment options that can more easily be implemented in community settings.

A variety of non-surgical interventions can be used to treat sBCC and BD including photodynamic therapy, cryosurgery, imiquimod cream, and 5-fluorouracil (5-FU). Using these therapeutic options may negate some of the risks presented with surgical interventions, but often yield higher recurrence rates and may prove to be intolerable in some individuals due to adverse effects. Emerging studies have begun to evaluate combination therapies to reduce the side effects of 
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