Squamous cell carcinoma of the skin medical therapy
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Squamous cell carcinoma of the skin Microchapters |
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Aditya Govindavarjhulla, M.B.B.S. [2], Raviteja Guddeti, M.B.B.S. [3]
Overview
Squamous cell carcinoma is a locally invasive tumor that can be treated successfully in up to 95% - 98% cases with a timely management. The available options for treatment are as follows
- Cryotherapy
- Electrosurgery (curettage and electrodessication)
- Topical therapy (5-Flourouracil, photodynamic therapy, and Imiquimod for cutaneous lesions.
While systemic treatment includes
- Radiation therapy
- Surgical excision
- Mohs Microsurgery
Medical Treatment
Medical care of Squamous cell carcinoma (SCC) includes cryosurgery, electrosurgery, topical treatment for cutaneous lesions and Radiation therapy and Chemotherapy for systemic disease.
- Cryotherapy destroys malignant cells by freezing and thawing. It is useful for small, well-defined, low-risk invasive SCCs and for Bowen's disease. In cryosurgery, liquid nitrogen is applied to the tumor and a surrounding rim of normal-appearing skin (usually ≥3 mm). The frozen area is then allowed to thaw unaided. In most cases, the tumor is refrozen to complete two freeze-thaw cycles; for Bowen's disease, a single freeze-thaw cycle may be sufficient.[1].Tumor cell death is due to the formation of intra and extracellular ice crystals, hypertonicity, disruption of the phospholipid membrane, and vascular stasis. Cryotherapy is a quick procedure and is cost-effective. This therapy is not indicated for large recurrent lesions,deeply invasive and other high risk SCC.
- Electrosurgery is usually employed if the lesion is small, well defined and located in non-critical areas of the body. It is also cost-effective, gives favorable cosmetic results and has a low complication rate. The procedure is performed by alternatively curetting away tumor and then electrodessicating the ulcer base including a rim of normal surrounding skin. Cure rates of nearly 96% can be achieved with this treatment provide the lesion is small and well defined. This treatment should be avoided on the mid-face region. It is contraindicated in recurrent, large, poorly defined and other high risk SCCs.
- Topical 5-fluorouracil (5-FU) is approved by the Food and Drug Administration (FDA) for the treatment of actinic keratoses. Although topical 5-FU is not approved for the treatment of SCC in situ, it is widely used for this indication when other treatment modalities are impractical and for patients who refuse surgical treatment. It is especially valuable for situations in which postoperative healing is compromised, such as lesions that involve the lower extremity in elderly patients or those with venous stasis disease. Topical 5-FU is also useful to treat the widespread SCC in situ lesions that may occur in arsenical dermatitis or xeroderma pigmentosum (XP).[2] Topical 5-FU is available in 5%, 1% and 0.5% concentrations. 1% and 0.5% are used for actinic keratosis. 5% cream is used twice daily for 4 - 8 weeks in the treatment of SCC in situ. Cure rates of up to 85% were achieved in one study with this type of treatment. For recurrent disease courses are repeated. It gives favorable cosmetic results. 5-FU is contraindicated in invasive lesions.
- Radiation therapy is an excellent choice for the management of initial small well defined lesions, primary SCCs especially for older individuals and those who are not candidates for a surgical procedure. This form of treatment is administered in a fractionated form requiring nearly 30 treatments. For low risk lesions the cure rate approaches nearly 90%. The main advantage of this kind of treatment is sparing of the surrounding normal healthy skin and thus providing superior cosmetic benefits.
Radiotherapy is contraindicated in
- Tumors located on the trunk, extremities, ear and nose.
- Patients younger than 40 and 50 years.
- Recurrent SCCs that are previously irradiated.
- In cancers with large and poorly defined lesions and other high risk SCCs.
In Nasopharyngeal squamous cell carcinoma Radiotherapy is the main stay of treatment along with Chemotherapy in advanced lesions. Here radiotherapy is administered to the tumor volume and also the adjoining lymph nodes. A multiinstitutional study showed that a dose of at least 66 Gy to the gross disease are needed for optimal control of the lesion.
References
- ↑ Holt PJ (1988). "Cryotherapy for skin cancer: results over a 5-year period using liquid nitrogen spray cryosurgery". Br. J. Dermatol. 119 (2): 231–40. PMID 3166941. Unknown parameter
|month=ignored (help) - ↑ Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML (2001). "Imiquimod 5% cream in the treatment of Bowen's disease". J. Am. Acad. Dermatol. 44 (3): 462–70. doi:10.1067/mjd.2001.111335. PMID 11209116. Unknown parameter
|month=ignored (help)
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