Basal cell carcinoma superficial

Superficial Spreading Nodular Lentigo Maligna Melanoma Acral Lentiginous Basal Cell Carcinoma Squamous Cell Carcinoma... 

Imiquimod cream is used for the treatment of external anogenital warts, where it may be used for both keratinised and non-keratinised lesions. It is also used in superficial basal cell carcinoma and actinic keratosis. Side-effects include local reactions such as itching, burning sensation, erythema, erosion, oedema, excoriation and stabbing and, less commonly, local ulceration. Patients should be advised to rub it in and to allow it to stay on the treated area for 6-10 hours for warts. The cream should then be washed off with mild soap and water. 

Superficial basal cell carcinoma (sBCC) For the topical treatment of biopsy-confirmed, primary sBCC in immunocompetent adults, with a maximum tumor diameter of 2 cm, located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured. 

Fluorouracil (Efudex, Fluoroplex) is an antimetabolite used for the topical treatment of actinic keratoses. It is also useful for the treatment of superficial basal cell carcinomas when conventional surgical modalities are impractical. Local inflammatory reactions characterized by erythema, edema, crusting, burning, and pain are common (and, some would argue, desirable) but may be minimized by reduced frequency of application or use in combination with a topical corticosteroid. 

Fluorouracil is used in several combination regimens in the treatment of breast cancer. It also has palliative activity in gastrointestinal adenocarcinomas, including those originating in the stomach, pancreas, liver, colon, and rectum. Other tumors in which some antitumor effects have been reported include carcinomas of the ovary, cervix, oropharynx, bladder, and prostate. Topical 5-fluorouracil cream has been useful in the treatment of premalignant keratoses of the skin and superficial basal cell carcinomas, but it should not be used in invasive skin cancer. 

Imiquimod should be applied to the wart tissue three times per week and left on the skin for 6-10 hours prior to washing off with mild soap and water. Treatment should be continued until eradication of the warts is accomplished, but not for more than a total of 16 weeks. Recommended treatment of actinic keratoses consists of twice-weekly applications on the contiguous area of involvement. The cream is removed after approximately 8 hours with mild soap and water. Treatment of superficial basal cell carcinoma consists of five-times-per-week application to the tumor, including a 1-cm margin of surrounding skin, for a 6-week course of therapy. 

Imiquimod (Aldara , a heterocyclic imidazoquinoline amide (the structure of which is shown in Fig. 2), is an immune response modifier that has potent antiviral and antitumor activities [12-16]. Imiquimod and resiquimod (the structure of which is also shown in Fig. 2) have been shown to be topical immune response modifiers [17]. Imiquimod is approved for the treatment of actinic keratoses, superficial basal cell carcinomas and warts it has also... 

Marks R, et al. Imiquimod 5% cream in the treatment of superficial basal cell carcinoma results of a multicenter 6-week dose-response trial. J Am Acad Dermatol 2001 44 807. 

Soler, A.M., Angell-Petersen, E., Warloe, T., Tausjo, J., Steen, H.B., Moan, J., and Giercksky, K.E. (2000) Photodynamic therapy of superficial basal cell carcinoma with 5-amino-levulinic acid with dimethylsulfoxide and ethylendiaminetetraacetic acid a comparison of two hght sources, Photochem. Photobiol., 71 724—729. 

Fluorouracil is a pyrimidine antimetabolite. The metabolism of fluorouracil in the anabolic pathway blocks the methylation reaction of deoxyuridylic acid to chymidylic acid. In this manner, fluorouracil interferes with the synthesis of DNA and to a lesser extent inhibits the formation of RNA. It is indicated in colon, rectum, breast, gastric, and pancreatic carcinoma (injection) multiple actinic or solar keratoses, and superficial basal-cell carcinoma (topical). 

COMBINATION THERAPY Higher response rates are seen when 5-FU is used in combination with other agents, such as cyclophosphamide and methotrexate (breast cancer), cisplatin (head and neck cancer), and with oxaliplatin or irinotecan in colon cancer. The combination of 5-FU and oxaliplatin or irinotecan has become the standard first-hne treatment for patients with metastatic colorectal cancer. The use of 5-FU in combination regimens has improved survival in the adjuvant treatment for breast cancer, and with oxaliplatin and leucovorin, for colorectal cancer. 5-FU also is a potent radiation sensitizer. Beneficial effects also have been reported when combined with irradiation for cancers of the esophagus, stomach, pancreas, cervix, anus, and head and neck. 5-FU is used widely with very favorable results for the topical treatment of premalignant keratoses of the skin and multiple superficial basal cell carcinomas. 

Incoherent (nonlaser) and laser light sources have been used for PDT. The wavelengths chosen must include those within the action spectrum of protoporphyrin and ideally those that permit maximum skin penetration. Light sources in use emit energy predominantly in the blue portion (maximum porphyrin absorption) or the red portion (better tissue penetration) of the visible spectrum. Nonhypertrophic actinic keratoses and superficial basal cell carcinomas and Bowen s disease seem to respond best to PDT. Topical ALA products for PDT approved by the FDA include LEVUIAN KERASTICK, BLU-U blue light, and METVIX. 

Fluorouracil (5-FU) interferes with DNA synthesis by blocking the methylation of deoxyuridylic acid to thymidylic acid. Topical formulations (carac, efudex, fluoroplex) are used in multiple actinic keratoses, actinic cheilitis, Bowen s disease, and superficial basal cell carcinomas not amenable to other treatments. 

P. Welf, E. Rieger, H. Kerl (1993). Topical photodynamic therapy with endogenous porphyrins after application of 5-aminolevulinic acid. An alternative treatment modality for solar keratoses, superficial squamous cell carcinomas, and basal cell carcinomas J. Am. Acad. Dermatol., 28, 17-21. 

A.F. Hurlimann, G. Hanggi, R.G. Panizzon (1998). Photodynamic therapy of superficial basal cell carcinomas using topical 5-aminolevulinic acid in a nanocolloid lotion. Dermatology, 197, 248-254. 

R. Fink-Puches, P. Wolf, H. Kerl (1997). Photodynamic therapy of superficial basal cell carcinoma by instillation of aminolevulinic acid and irradiation with visible light [see comments]. Arch. Dermatol., 133, 1494-1495. 

Photodynamic therapy (PDT) with various photosensitizers has been proven to be highly efficient in the treatment of skin tumors. However, most valid data are available for ALA only, which has been shown to effectively sensitize solar keratoses and superficial basal cell carcinomas with porphyrins. Initial squamous cell carcinomas also show good response to ALA-PDT. Treatment of psoriasis by PDT is a subject under investigation. During the last decade numerous studies on PDT for dermatological diseases have been published, the more important ones are reviewed here. 

O. Santoro, G. Bandieramonte, E. Melloni, R. Marchesini, F. Zunino, P. Lepera, G. De Palo (1990). Photodynamic therapy by topical meso-tetraphenylporphyrinesulfonate tetrasodium salt administration in superficial basal cell carcinomas. Cancer Res., 50, 4501 503. 

A.M. Wennberg, L.E. Lindholm, M. Alpsten, O. Larko (1996). Treatment of superficial basal cell carcinomas using topically applied delta-aminolaevulinic acid and a filtered xenon lamp. Arch. Dermatol Res., 88, 561-564. 

Clinical use Fluorouracil is used in bladder, breast, colon, head and neck, liver, and ovarian cancers. The drug can be used topically for keratoses and superficial basal cell carcinoma. 

Basal cell carcinoma (BCC) is a skin cancer with a local malignancy. The superficial type can be treated with PDT. 

Vitiligo-like depigmentation was reported at the site of treatment with topical imiquimod in a 65-year-old man and 54-year-old woman treated for superficial basal cell carcinoma. Symptoms persisted at 6 months after therapy [354A],... 

Keratoacanthoma was reported at the site of topical application of imiquimod in a 62-year-old man treated for superficial basal cell carcinoma. A nodular lesion developed eight weeks after treatment. Histology of a localised biopsy confirmed keratoacanthoma [356 ]. 

Therapeutic applications Fluorouracil is employed primarily in the treatment of slowly growing, solid tumors (for example, colorectal, breast, ovarian, pancreatic, and gastric carcinomas). Adjuvant therapy with levamisole, a veterinary anthelmintic agent, improves the survival of patients with colonic cancer. 5-FU is also effective for the treatment of superficial basal cell carcinom when applied topically. 

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