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Advances in Topical Treatments of Cutaneous Malignancies

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Abstract

Surgical excision has been the preferred treatment for cutaneous malignancies, but can be affected by various considerations. Noninvasive, self-administered topical treatments represent an alternative option. The aim of this review was to evaluate and summarize evidence-based recommendations for topical treatments of basal cell carcinoma (BCC), cutaneous squamous cell carcinoma (CSCC), in situ melanoma (MIS), and extramammary Paget’s disease (EMPD). Studies were reviewed on PubMed. Included studies were summarized, assessed for biases, and assigned a level of evidence to develop treatment recommendations. For the treatment of superficial BCC, complete clearance rates ranged from 90 to 93% for 5% 5-fluorouracil (5-FU) and 71 to 76% for imiquimod (IMQ). For the treatment of nodular BCC, clearance rates for photodynamic therapy (PDT) were 91% at 3 months, with a sustained lesion clearance response rate of 76% after 5 years of follow-up. Clearance rates were 53 to 76% with IMQ. For squamous cell carcinoma in situ, clearance rates ranged from 52 to 98% for PDT, 67 to 92% for 5-FU, and 75 to 93% for IMQ. For MIS, clearance rates ranged from 53 to 92% for IMQ. For EMPD, 54% of 110 patients in cohort studies and case series had a clinical complete response with IMQ. While surgical intervention remains the standard of care for skin cancer, non-invasive, self-administered topical treatments are highly desirable alternative options. Ultimately, the patient and provider should find a treatment modality that aligns with the patient’s expectations and maintenance of quality of life.

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Authors and Affiliations

  1. Eastern Virginia Medical School, Norfolk, VA, USA

    Yanci A. Algarin

  2. Department of Dermatology, The University of Texas at Austin, Austin, TX, USA

    Anokhi Jambusaria-Pahlajani

  3. Department of Dermatology, Brigham and Women’s Hospital, Boston, MA, USA

    Emily Ruiz

  4. Department of Dermatology, The George Washington School of Medicine and Health Sciences, 2150 Pennsylvania Avenue 2B, NW, Washington, DC, 20037, USA

    Vishal A. Patel

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Authors YAA, AJ, and ER declare that they have no conflicts of interest that might be relevant to the contents of this manuscript. VAP declares he has received honoraria for advisory boards from Almirall, Inc., and PhD Biosciences. 

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YAA assisted with writing the manuscript and created Table 1. AJ assisted with writing the manuscript. ER assisted with writing the manuscript. VAP assisted with writing the manuscript. All authors reviewed the final manuscript.

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Algarin, Y.A., Jambusaria-Pahlajani, A., Ruiz, E. et al. Advances in Topical Treatments of Cutaneous Malignancies. Am J Clin Dermatol 24, 69–80 (2023). https://doi.org/10.1007/s40257-022-00731-x

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