RESUMO
BACKGROUND: Treatment strategies for cutaneous squamous cell carcinoma in situ (cSCCIS) are many but reported cure rates are variable and few studies report 5-year follow-up data. OBJECTIVE: To evaluate the treatment of cSCCIS by curettage followed by topical imiquimod 5% cream (C&I). METHODS: We evaluated all immunocompetent patients with biopsy proven cSCCIS treated by C&I between January 2008 and December 2012. RESULTS: A total of 861 patients with 1,198 cSCCIS were treated, with median follow-up of 71 months. The mean tumor diameter was 10.2 mm. The average duration of treatment with imiquimod 5% cream was 21 days. Kaplan-Meier estimated recurrence-free survival at 5-year follow-up was 99.71% with 95% CI (99.38%, 100.00%). A follow-up questionnaire returned by 45% of patients revealed that 94% were satisfied with their treatment. Six hundred eleven patients developed a new nonmelanoma skin cancer (NMSC) during the follow-up period, and 91% (556/611) of patients chose this combination treatment for at least one new NMSC. CONCLUSION: The combination treatment for cSCCIS of C&I had less than 1% cumulative probability of treatment failure at 5 years. Patients tolerated the treatment well, with the majority choosing this method of treatment for at least one new NMSC.
Assuntos
Carcinoma de Células Escamosas/tratamento farmacológico , Carcinoma de Células Escamosas/cirurgia , Curetagem , Imiquimode/administração & dosagem , Neoplasias Cutâneas/tratamento farmacológico , Neoplasias Cutâneas/cirurgia , Administração Cutânea , Adulto , Idoso , Idoso de 80 Anos ou mais , Antineoplásicos/administração & dosagem , Terapia Combinada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e QuestionáriosRESUMO
BACKGROUND: Most actinic keratoses (AKs) respond to standard treatments, but a subset persist and require further intervention. We report a series of 10 patients with AKs that failed to respond to conventional treatment with cryotherapy and topical monotherapy but responded completely to simultaneous therapy with topical 5-fluorouracil (5-FU) and imiquimod creams. OBJECTIVE: To report the success of this combination therapy in refractory AKs and to determine whether any clinical or histologic features predict for treatment resistance. METHODS: Case-control study with two control groups matched to each patient according to lesion location and sex. RESULTS: Mean lesion diameter (p < .001), lesion diameter greater than 1 cm (p < .001), and the presence of pain (p = .01) were statistically associated with failure of cryotherapy and topical monotherapy. None of the histologic features evaluated were found to be statistically significant, although thicker epidermis was nearly so (p = .054). CONCLUSIONS: In patients who have failed standard therapy for AKs, combination treatment using topical 5-FU and imiquimod cream may be an effective alternative therapeutic strategy. Larger lesion diameter, specifically greater than 1 cm, and the presence of pain predict conventional treatment resistance.
Assuntos
Aminoquinolinas/uso terapêutico , Antineoplásicos/uso terapêutico , Fluoruracila/uso terapêutico , Ceratose Actínica/tratamento farmacológico , Ceratose Actínica/patologia , Idoso , Idoso de 80 Anos ou mais , Análise de Variância , Antimetabólitos Antineoplásicos/uso terapêutico , Estudos de Casos e Controles , Distribuição de Qui-Quadrado , Criocirurgia , Quimioterapia Combinada , Feminino , Humanos , Imiquimode , Ceratose Actínica/cirurgia , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Falha de TratamentoRESUMO
A woman had cutaneous, mucosal, and possible visceral leishmaniasis simultaneously. Many of her cutaneous lesions consisted of boggy indurations rather than customary papules, nodules, or ulcers. This unusual case was finally cured after four courses of miltefosine, one course of antimony, and two courses of Ambisome.
Assuntos
Anfotericina B/uso terapêutico , Antiprotozoários/uso terapêutico , Leishmaniose Cutânea/patologia , Fosforilcolina/análogos & derivados , Antimônio/uso terapêutico , Biópsia , Bolívia , Quimioterapia Combinada , Feminino , Humanos , Pessoa de Meia-Idade , Fosforilcolina/uso terapêutico , Viagem , Resultado do TratamentoAssuntos
Agonistas de Receptores Adrenérgicos alfa 1 , Agonistas alfa-Adrenérgicos/uso terapêutico , Eritema/tratamento farmacológico , Rubor/tratamento farmacológico , Oximetazolina/uso terapêutico , Rosácea/complicações , Idoso , Eritema/etiologia , Eritema/patologia , Feminino , Rubor/etiologia , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente , Telangiectasia/tratamento farmacológico , Telangiectasia/etiologia , Resultado do TratamentoRESUMO
Topical therapeutic options for cutaneous squamous cell carcinoma in situ include 5-fluorouracil cream and imiquimod cream. Such treatment may be preferable to surgical or destructive modalities in certain anatomic locations and in instances where patients are unwilling or poor surgical candidates. We present 4 such patients with cutaneous squamous cell carcinoma in situ involving a digit. Each patient failed treatment with imiquimod cream as monotherapy. In addition, two patients failed treatment with 5-fluorouracil cream as monotherapy. All 4 responded completely to 5-fluorouracil and imiquimod cream as combination therapy. In patients who have failed monotherapy with a topical agent for cutaneous squamous cell carcinoma in situ, combination treatment using both topical 5-fluorouracil cream and imiquimod cream may be considered as an alternative therapeutic strategy.