Combination Topical Chemotherapy for the Treatment of an Invasive Cutaneous Squamous Cell Carcinoma
Combination Topical Chemotherapy for the Treatment of an Invasive Cutaneous Squamous Cell Carcinoma
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DOI：
10.36849/jdd.2020.2228
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发表时间：
2020-02-01
影响因子：
1.5
通讯作者：
Shen, John
中科院分区：
文献类型：
--
作者：
Fayne, Rachel;Nanda, Sonali;Shen, John
简介：鳞状细胞癌（SCC）的标准治疗通常是手术，包括切除或莫氏显微手术。然而，手术可能不是理想的老年患者与许多病变，谁是穷人的手术候选人或拒绝手术。局部5-氟尿嘧啶（5-FU）和咪喹莫特已被研究标签外作为单一疗法在原位治疗SCC有希望的结果。然而，长期无瘤生存率仍然低于手术management.Methods：我们报告一例活检证实的浸润性SCC在一个86岁的白人男性与历史的多个光化性角化病，没有以前的皮肤癌。由于担心美容结果，患者拒绝手术治疗。局部5%咪喹莫特乳膏、2%5-FU溶液和0.1%维甲酸乳膏的组合每周在封闭下使用五个晚上，治疗目标为总共30次应用。每2周在诊所对患者进行一次评估，在此期间对该部位进行冷冻治疗。患者报告与治疗相关的灼热疼痛，只完成了24的30 application.Results：完成局部治疗后15个月的随访活检显示皮肤瘢痕，没有证据表明残留cancer.Conclusion：局部联合治疗与咪喹莫特，5-FU，和维甲酸与间歇性，短暂的冷冻治疗有效地治疗了一个小的，侵入性SCC在这个选择的患者谁推迟手术。有必要进行前瞻性随机对照临床试验，以评估联合局部治疗对侵袭性SCC的作用。
Introduction: Standard of care for squamous cell carcinoma (SCC) is usually surgical, with either excision or Mohs micrographic surgery. However, surgery may not be ideal for elderly patients with numerous lesions, who are poor surgical candidates or who refuse surgery. Topical 5-fluorouracil (5-FU) and imiquimod have been studied off-label as monotherapies in the treatment of SCC in situ with promising results. However, long-term tumor-free survival rates are still less than with surgical management.Methods: We report a case of biopsy-proven invasive SCC in an 86-year-old Caucasian male with history of multiple actinic keratoses and no previous skin cancers. The patient declined surgical treatment due to concerns about cosmetic outcomes. A combination of topical 5% imiquimod cream, 2% 5-FU solution, and 0.1 % tretinoin cream was used five nights per week under occlusion for a treatment goal of 30 total applications. The patient was evaluated in clinic every 2 weeks during which the site was treated with cryotherapy. The patient reported burning pain associated with treatment and only completed 24 of the 30 applications.Results: Follow-up biopsy 15 months after completing topical treatment revealed dermal scar with no evidence of residual carcinoma.Conclusion: Topical combination therapy with imiquimod, 5-FU, and tretinoin with intermittent, brief cryotherapy effectively treated a small, invasive SCC in this select patient who deferred surgery. Prospective randomized-controlled clinical trials to assess the role of combination topical treatment for invasive SCCs are warranted.