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)