INTRODUCTION
Non-melanoma skin cancer (NMSC) is the most common cancer in the United States, with an estimated 3 million individuals affected in 2012.1-3 Management strategies for NMSC include electrodessication & curettage, wide local excision, Mohs micrographic surgery (MMS).4-8 Surgical excision remains the gold standard, with MMS offering one the highest cure and lowest recurrence rate.9
Although cost is not the single factor that determines treatment type, the average cost for treatment with excision and MMS are $1,222 and $2,085, respectively.10 It is important to consider alternative therapies that are cost-effective, especially for patients who are poor surgical candidates.11,12 Non-surgical treatments commonly used in management of NMSC include topical imiquimod and topical 5-fluorouracil (5-FU).13 These agents are effective in the treatment of the superficial variant of basal cell carinoma (BCC) and have been approved by the US Food and Drug Administration (FDA).14 Intralesional therapy using chemotherapeutics such as 5-fluorouracil and bleomycin have been routinely used to treat NMSC, however, there are no guidelines for the use of intralesional therapy for NMSC.15,16 In contrast to MMS, IL 5-FU is an inexpensive regimen; the cost of a 50 ml vial of IL 5-FU ranges from $19.50–$26.00.16 We performed a systematic review investigating the efficacy of IL 5-FU as a monotherapy in the treatment of squamous cell carcinoma (SCC), keratoacanthoma (KA), and BCC.
Although cost is not the single factor that determines treatment type, the average cost for treatment with excision and MMS are $1,222 and $2,085, respectively.10 It is important to consider alternative therapies that are cost-effective, especially for patients who are poor surgical candidates.11,12 Non-surgical treatments commonly used in management of NMSC include topical imiquimod and topical 5-fluorouracil (5-FU).13 These agents are effective in the treatment of the superficial variant of basal cell carinoma (BCC) and have been approved by the US Food and Drug Administration (FDA).14 Intralesional therapy using chemotherapeutics such as 5-fluorouracil and bleomycin have been routinely used to treat NMSC, however, there are no guidelines for the use of intralesional therapy for NMSC.15,16 In contrast to MMS, IL 5-FU is an inexpensive regimen; the cost of a 50 ml vial of IL 5-FU ranges from $19.50–$26.00.16 We performed a systematic review investigating the efficacy of IL 5-FU as a monotherapy in the treatment of squamous cell carcinoma (SCC), keratoacanthoma (KA), and BCC.
METHODS
A comprehensive systematic review was performed using PubMed/Medline, Embase and Web of Science databases. The search included the following terms: “Keratinocyte Carcinomaâ€, “cutaneous, squamous cell†or “Basal cell carcinomaâ€, “keratoacanthoma†or “SCC-KA type†or “Bowen’s diseaseâ€, “SCC In Situ†in combination with “Intralesionalâ€, “Intradermalâ€, “5-Flurouracilâ€, “5FUâ€.
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.18 Studies were searched from inception to February 2020.
125 studies were identified using the search terms. Full-text articles reporting IL 5-FU for the treatment of SCC, BCC and KA with reported outcome measures were included. There were no geographical or language restrictions. The following study types were excluded: 1) studies using oral systemic and/or topical agents in combination; 2) studies with patients on systemic chemotherapeutics known to induce keratinocyte carcinomas (ie, epidermal-growth factor receptor inhibitors); 3) studies that used adjunct radiotherapy.
125 articles were reviewed by at least two authors (JM, DK) and were screened by title and abstract; of 125 articles, 28 were eligible for full text review. 19 studies met the inclusion criteria and nine studies were excluded.19-27
We used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.18 Studies were searched from inception to February 2020.
125 studies were identified using the search terms. Full-text articles reporting IL 5-FU for the treatment of SCC, BCC and KA with reported outcome measures were included. There were no geographical or language restrictions. The following study types were excluded: 1) studies using oral systemic and/or topical agents in combination; 2) studies with patients on systemic chemotherapeutics known to induce keratinocyte carcinomas (ie, epidermal-growth factor receptor inhibitors); 3) studies that used adjunct radiotherapy.
125 articles were reviewed by at least two authors (JM, DK) and were screened by title and abstract; of 125 articles, 28 were eligible for full text review. 19 studies met the inclusion criteria and nine studies were excluded.19-27
