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Medical
Treatment of Skin Cancer and Precancers:
- Topical Field therapy
- COX-2 inhibitors (Actinic keratosis)
- Topical Retinoids (Actinic keratosis, superficial BCC)
- 5-FU (Actinic keratosis, superficial BCC, SCC in-situ)
- Effudex® or Carac®
- Topical chemotherapy for the skin
- Excellent choice for numerous actinic keratoses
- Preferentially absorbed by the precancerous or cancerous cells
- Apply 2x/day for 3-4 weeks
- Skin turns red and crusty- like a very bad sunburn
- Visible and sub-clinical lesions "light up"
- Imiquimod (Actinic keratosis, superficial BCC, SCC in-situ)
- Immune response modulator
- Stimulates the immune system in the skin to recognize and destroy
precancerous and cancerous cells
- Cream is applied several times a week
- Skin turns red and crusty during the course of treatment- if no
reaction occurs, need to increase the frequency of application
- Bleomycin
- Acitretin
- Reduces the rate at which new skin cancers appear
- Benefit only when taking medication
- Potential candidates: patients with >5 skin cancers /year
- Side effects: liver toxicity, elevated cholesterol, dry skin
- Average required dose: 25-30mg/day(13)
- Begin with acitretin 10 mg qD then titrated upwards as tolerated
- Side effects include but are not limited to:
- Hyperlipidemia
- Dry skin
- Hepatotoxicty
- Radiation
- Chemotherapy(9)
- Reduction of immunosuppression(10)
- Consider when benefits outweigh risks
- Potential candidates:
- Metastatic skin cancer of any type
- >5 to 10 skin cancers/year
- Kaposi's Sarcoma
- Post Transplant Lymphoproliferative Disorder
- Consider adjusting immunosuppressive regimen
- Switch to less carcinogenic medications (14)
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