Treatment of skin malignancies

,

Applied Evidence

Treatment of skin malignancies

J Fam Pract. 2003 June;52(6):456-464

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References

1. Strayer SM, Reynolds PL. Diagnosing skin malignancy: assessment of predictive clinical criteria and risk factors. J Fam Pract 2003;52:210-218.

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Imiquimod 5% cream also shows great promise for the treatment of superficial basal cell carcinoma. This cytokine and interferon inducer is primarily used for treatment of external genital and anal warts. Twice daily, once daily, or 3 times weekly application over 10 to 16 weeks produces histological clearing of low-risk, small superficial basal cell carcinoma (LOE: 2b).³² Adverse events are limited to local skin reactions with severity increasing with more frequent dosing. Research examining rates of recurrence is ongoing. As with 5-FU, effectiveness for large tumors and those at high-risk locations has not been established.

Radiotherapy

Currently, radiotherapy is used in special situations, such as nonmelanoma skin cancer near the eye, nose, and ear (LOE: 5).²² In specialty centers, radiation is used in conjunction with other modalities for recurrent or highly aggressive lesions.

While cure rates in low-risk areas are over 90%, long-term cosmesis, particularly for young patients with basal cell carcinoma, is less favorable than with other modalities.²⁰ Other disadvantages include long-term radiation risks, high cost, and need for multiple visits over several weeks.²²

Follow-up

Periodic population-based screening for non-melanoma skin cancer has not been proven to extend life. However, in patients who have already had nonmelanoma skin cancer, periodic surveillance is probably important.

Of patients with squamous cell carcinoma, 30% will develop an additional squamous cell carcinoma after 5 years and over 50% will develop an additional nonmelanoma skin cancer.³³ More than one third of patients with basal cell carcinoma will develop an additional basal cell carcinoma after 5 years.³³

One accepted approach is to have patients with newly diagnosed nonmelanoma skin cancer follow-up every 3 months for the first year and then at 6-month intervals thereafter (LOE: 5).⁵ New primary lesions should be treated accordingly, while recurrent lesions may be referred to a dermatologist.

Acknowledgments

The authors wish to thank Barbara Zuckerman and Michael Campese, PhD for their assistance in preparation of this manuscript.

Corresponding author
Scott M. Strayer, MD, MPH, University of Virginia Health System, Department of Family Medicine, P.O. Box 800729, Charlottesville, VA 22908-0729. E-mail: sstrayer@virginia.edu.