Skin Cancer pp 301-314 | Cite as

Topical Treatment

  • Miguel Alejandro LópezEmail author
Part of the Current Clinical Pathology book series (CCPATH)


There are several therapeutic modalities to treat various types of skin cancer. In general, in the early stages of most common skin cancers, the surgical option by removing the tumor and leaving an adequate oncologic margin is usually the best and most used option; in addition, surgery generally offers the best chance of cure with the advantage of having histopathologic evaluation of the excised margins. In other less frequent malignant neoplastic diseases such as mycosis fungoides and Kaposi’s sarcoma, topical treatment is an option and even a choice option in the early stages of the disease.


Basal Cell Carcinoma Visceral Leishmaniasis Actinic Keratosis Mycosis Fungoides Erythema Multiforme 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.




9-cis Retinoic Acid

Nitrogen Mustard

Mechlorethamine hydrochloride




  1. 1.
    Miller SJ, Moresi JM, et al. Actinic keratosis, basal cell carcinoma and squamous cell carcinoma. In: Bolognia JL, editor. Dermatology. 1st ed. Philadelphia: Elsevier Mosby; 2003.Google Scholar
  2. 2.
    Greenway HT, Maggio KL, et al. Mohs micrographic surgery and cutaneous oncology. In: Robinson JK, editor. Surgery of the skin. Procedural Dermatology. Philadelphia: Elsevier Mosby; 2005.Google Scholar
  3. 3.
    Ceilley RI, Del Rosso JQ. Topical chemotherapy for the treatment of skin cancer. In: Rigel DS, editor. Cancer of the skin. Madrid: 1st ed. Elsevier; 2004.Google Scholar
  4. 4.
    Wyatt EL, Sutter SH, Drake LA. Dermatological pharmacology. In: Hardman JG, Limbird LE, editors. Goodman & Gilman’s the pharmaceutical basis of therapeutics. 10th ed. New York: McGraw Hill; 2001.Google Scholar
  5. 5.
    Amini S, Viera MH, Valins W, Berman B. Nonsurgical innovations in the treatment of nonmelanoma skin cancer. J Clin Aesthet Dermatol. 2010;3(6):20–34.Google Scholar
  6. 6.
    Bargman H, Hochman J. Topical treatment of Bowen’s disease with 5-fluorouracil. J Cutan Med Surg. 2003;7(2):101–5.PubMedCrossRefGoogle Scholar
  7. 7.
    Gross K, Kircik L, Kricorian G. 5 % 5-fluorouracil cream for the treatment of small superficial basal cell carcinoma: efficacy, tolerability, cosmetic outcome, and patient satisfaction. Dermatol Surg. 2007;33:433–40.PubMedCrossRefGoogle Scholar
  8. 8.
    Epstein E. Fluorouracil paste treatment of thin basal cell carcinoma. Arch Dermatol. 1985;121:207–13.PubMedCrossRefGoogle Scholar
  9. 9.
    Orenberg EK, Miller BH, Greenway HT, Koperski JA, Lowe N, Rosen T, et al. The effect of intralesional 5-fluorouracil therapeutic implant (MPI 5003) for treatment of basal cell carcinoma. J Am Acad Dermatol. 1992;27:723–8.PubMedCrossRefGoogle Scholar
  10. 10.
    Love WE, Bernhard JD, Bordeaux JS. Topical imiquimod or fluorouracil therapy for basal and squamous cell carcinoma: a systematic review. Arch Dermatol. 2009;145:1431–8.PubMedCrossRefGoogle Scholar
  11. 11.
    Askew DA, Mickan SM, Soyer HP, Wilkinson D. Effectiveness of 5-fluorouracil treatment for actinic keratosis-a systematic review of randomized controlled trials. Int J Dermatol. 2009;48(5):453–63.PubMedCrossRefGoogle Scholar
  12. 12.
    Dinehart SM. The treatment of actinic keratoses. J Am Acad Dermatol. 2000;42(1 Pt 2):25–8.PubMedCrossRefGoogle Scholar
  13. 13.
    Epstein E. Treatment of lip keratoses (actinic cheilitis) with topical fluorouracil. Arch Dermatol. 1977;113(7):906–8.PubMedCrossRefGoogle Scholar
  14. 14.
    Kossow AS, Cotelingam JD, MacFarland F. Bowenoid papulosis of the penis. J Urol. 1981;125(1):124–6.PubMedGoogle Scholar
  15. 15.
    Litt JZ. Pocketbook of drug eruptions and interactions. New York: Parthenon Publishing; 2004.Google Scholar
  16. 16.
    Mackenzie-Wood A, Kossard S, de Launey J, Wilkinson B, Owens ML. Imiquimod 5 % cream in the treatment of Bowen’s disease. J Am Acad Dermatol. 2001;44(3):462–70.PubMedCrossRefGoogle Scholar
  17. 17.
    Wu JK, Siller G, Whitehead K. Treatment of Bowen’ disease and basal cell carcinoma of the nose with imiquimod 5 % cream. Australas J Dermatol. 2003;44(2):123–5.PubMedCrossRefGoogle Scholar
  18. 18.
    Schroeder TL, Sengelmann RD. Squamous cell carcinoma in situ of the penis successfully treated with imiquimod 5 % cream. J Am Acad Dermatol. 2002;46(4):545–8.PubMedCrossRefGoogle Scholar
  19. 19.
    Beutner KR, Geisse JK, Helman D, et al. Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5 % cream. J Am Acad Dermatol. 1999;41:1002–7.PubMedCrossRefGoogle Scholar
  20. 20.
    Geisse J, Rich P, Pandya A, et al. Imiquimod 5 % cream for the treatment of superficial basal cell carcinoma: a double blind randomized, vehicle controlled study. J Am Acad Dermatol. 2002;47:390–8.PubMedCrossRefGoogle Scholar
  21. 21.
    Berman B, Villa A. Moduladores inmunitarios en el tratamiento del cancer de piel. In: Rigel DS, editor. Cancer de piel. 1st ed. Madrid: Elsevier; 2006.Google Scholar
  22. 22.
    Geisse J, Caro I, Lindholm J, Golitz L, Stampone P, Owens M. Imiquimod 5 % cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol. 2004;50(5):722–33.PubMedCrossRefGoogle Scholar
  23. 23.
    Schulze HJ, Cribier B, Requena L, et al. Imiquimod 5 % cream for the treatment of superficial basal cell carcinoma: results from a randomized vehicle-controlled phase III study in Europe. Br J Dermatol. 2005;152(5):939–47.PubMedCrossRefGoogle Scholar
  24. 24.
    Gollnick H, Barona CG, Frank RGJ, et al. Recurrence rate of superficial basal cell carcinoma following successful treatment with imiquimod 5 % cream: interim 2-year results from an ongoing 5-year follow-up study in Europe. Eur J Dermatol. 2005;15(5):374–81.PubMedGoogle Scholar
  25. 25.
    Eigentler TK, Kamin A, Weide BM, et al. A phase III, randomized, open label study to evaluate the safety and efficacy of imiquimod 5 % cream applied thrice weekly for 8 and 12 weeks in the treatment of low-risk nodular basal cell carcinoma. J Am Acad Dermatol. 2007;57(4):616–21.PubMedCrossRefGoogle Scholar
  26. 26.
    Edwards L, Owens ML, Andres KL, et al. A pilot study evaluating imiquimod 5 % cream versus vehicle in the treatment of actinic keratoses. Poster presented at the 58th annual meeting of the American Academy of Dermatology, San Francisco, 10–15 Mar 2000.Google Scholar
  27. 27.
    Salasche SJ, Levine N, Morrison L. Cycle therapy of actinic keratoses of the face and scalp with 5 % topical imiquimod cream: an open-label trial. J Am Acad Dermatol. 2002;47(4):571–7.PubMedCrossRefGoogle Scholar
  28. 28.
    Stockfleth E, Sterry W, Carey-Yard M, Bichel J. Multicentre, open-label study using imiquimod 5 % cream in one or two 4-week courses of treatment for multiple actinic keratoses on the head. Br J Dermatol. 2007;157 Suppl 2:41–6.PubMedCrossRefGoogle Scholar
  29. 29.
    Szeimies RM, Gerritsen MJ, Gupta G, et al. Imiquimod 5 % cream for the treatment of actinic keratosis: results from a phase III, randomized, double-blind, vehicle-controlled, clinical trial with histology. J Am Acad Dermatol. 2004;51(4):547–55.PubMedCrossRefGoogle Scholar
  30. 30.
    Gupta AK, Davey V, McPhail H. Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: critical review and meta-analysis of efficacy studies. J Cutan Med Surg. 2005;9(5):209–14.PubMedCrossRefGoogle Scholar
  31. 31.
    Smith KJ, Germain M, Yeager J, Skelton H. Topical 5 % imiquimod for the therapy of actinic cheilitis. J Am Acad Dermatol. 2002;47(4):497–501.PubMedCrossRefGoogle Scholar
  32. 32.
    Ahmed I, Berth-Jones J. Imiquimod: a novel treatment for lentigo maligna. Br J Dermatol. 2000;143(4):843–5.PubMedCrossRefGoogle Scholar
  33. 33.
    Naylor MF, Crowson N, Kuwahara R, Teague K, Garcia C, Mackinnis C, et al. Treatment of lentigo maligna with topical imiquimod. Br J Dermatol. 2003;149 Suppl 66:66–70.PubMedCrossRefGoogle Scholar
  34. 34.
    Van Meurs T, Van Doorn R, Kirtschig G. Treatment of lentigo maligna with imiquimod cream: a long-term follow-up study of 10 patients. Dermatol Surg. 2010;36(6):853–8.PubMedCrossRefGoogle Scholar
  35. 35.
    Demirci H, Shields CL, Bianciotto CG, Shields JA. Topical imiquimod for periocular lentigo maligna. Ophthalmology. 2010;117(12):2424–9.PubMedCrossRefGoogle Scholar
  36. 36.
    Narayan R, Nguyen H, Bentow JJ, et al. Immuno modulation by imiquimod in patients with high-risk primary melanoma. J Invest Dermatol. 2012;132:163–9. doi: 10.1038/jid.2011.247.PubMedCrossRefGoogle Scholar
  37. 37.
    Sigüenza M, Pizarro A, Mayor M, et al. Tratamiento tópico de las metástasis cutáneas de melanoma con imiquimod. Actas Dermosifiliogr. 2005;96(2):111–5.PubMedCrossRefGoogle Scholar
  38. 38.
    Turza K, Dengel LT, Harris RC, et al. Effectiveness of imiquimod limited to dermal melanoma metastases, with simultaneous resistance of subcutaneous metastasis. J Cutan Pathol. 2010;37(1):94–8.PubMedCrossRefGoogle Scholar
  39. 39.
    de Quatrebarbes J, Estève E, Bagot M, et al. Treatment of early-stage mycosis fungoides with twice-weekly applications of mechlorethamine and topical corticosteroids: a prospective study. Arch Dermatol. 2005;141(9):1117–20.PubMedCrossRefGoogle Scholar
  40. 40.
    Kim YH. Management with topical nitrogen mustard in mycosis fungoides. Dermatol Ther. 2003;16(4):288–98.PubMedCrossRefGoogle Scholar
  41. 41.
    Zackheim HS. Topical carmustine (BCNU) for patch/plaque mycosis fungoides. Semin Dermatol. 1994;13(3):202–6.PubMedGoogle Scholar
  42. 42.
    Zackheim HS, Epstein Jr EH, McNutt NS, et al. Topical carmustine (BCNU) for mycosis fungoides and related disorders: a 10-year experience. J Am Acad Dermatol. 1983;9(3):363–74.PubMedCrossRefGoogle Scholar
  43. 43.
    González-de-Arriba A, Pérez-Gala S, Goiriz-Valdés R, Ríos-Buceta L, García-Díez A. Sarcoma de Kaposi clásico tratado con alitretinoína tópica. Actas Dermosifiliogr. 2007;98(1):50–3.PubMedCrossRefGoogle Scholar
  44. 44.
    Bodsworth NJ, Bloch M, Bower M, et al. Phase III vehicle-controlled, multi-centered study of topical alitretinoin gel 0.1 % in cutaneous AIDS-related Kaposi’s sarcoma. Am J Clin Dermatol. 2001;2(2):77–87.PubMedCrossRefGoogle Scholar
  45. 45.
    Breneman D, Duvic M, Kuzel T, et al. Phase 1 and 2 trial of bexarotene gel for skin-directed treatment of patients with cutaneous T-cell lymphoma. Arch Dermatol. 2002;138(3):325–32.PubMedCrossRefGoogle Scholar
  46. 46.
    Heald P, Mehlmauer M, Martin AG, et al. Topical bexarotene therapy for patients with refractory or persistent early-stage cutaneous T-cell lymphoma: results of the phase III clinical trial. J Am Acad Dermatol. 2003;49(5):801–15.PubMedCrossRefGoogle Scholar
  47. 47.
    Nelson C, Rigel D. Long-term follow up of diclofenac sodium 3 % in 2.5 % hyaluronic acid gel for actinic keratosis: One-year evaluation. J Clin Aesthet Dermatol. 2009;2(7):20–5.PubMedGoogle Scholar
  48. 48.
    Wolf Jr JE, Taylor JR, Tschen E, Kang S. Topical 3.0 % diclofenac in 2.5 % hyaluronan gel in the treatment of actinic keratoses. Int J Dermatol. 2001;40:709–13.PubMedCrossRefGoogle Scholar
  49. 49.
    Nelson C, Rigel D, Smith S, Swanson N, Wolf J. Phase IV, open-label assessment of the treatment of actinic keratosis with 3.0 % diclofenac sodium topical gel (Solaraze™). J Drugs Dermatol. 2004;3(4):401–7.PubMedGoogle Scholar
  50. 50.
    Clive S, Leonard RCF. Miltefosine in recurrent cutaneous breast cancer. Lancet. 1997;349:621–2.PubMedCrossRefGoogle Scholar
  51. 51.
    Terwogt JMM, Mandjes IAM, Sindermann H, Beijnen JH, BokkelHuinink WW. Phase II trial of topically applied miltefosine solution in patients with skin-metastasized breast cancer. Br J Cancer. 1999;79(7/8):1158–11613.PubMedCrossRefGoogle Scholar
  52. 52.
    Epstein JB, Wong FL, Millner A, Le ND. Topical bleomycin treatment of oral leukoplakia: a randomized double-blind clinical trial. Head Neck. 1994;16:539–44.PubMedCrossRefGoogle Scholar
  53. 53.
    Epstein JB, Gorsky M, Wong FL, Millner A. Topical bleomycin for the treatment of dysplastic oral leukoplakia. Cancer. 1998;83:629–34.PubMedCrossRefGoogle Scholar
  54. 54.
    Watring WG, Roberts JA, Lagasse LD, Berman ML, Ballon SC, Moore JG, et al. Treatment of recurrent Paget’s disease of the vulva with topical bleomycin. Cancer. 1978;41:10–1.PubMedCrossRefGoogle Scholar
  55. 55.
    Poignonec S, Lachiver LD, Lamas G, et al. Intralesional bleomycin for acquired inmuno-deficiency syndrome-associated cutaneous Kaposi’s sarcoma. Arch Dermatol. 1995;131:228.PubMedCrossRefGoogle Scholar
  56. 56.
    Jorizzo J, Carney P, Ko W. Treatment options in the management of actinic keratosis. Cutis. 2004;74:9–17.PubMedGoogle Scholar
  57. 57.
    Barrera MV, Herrera E. Tratamiento quimioterápico tópico de la queratosis actínica y el cáncer cutáneo no melanoma: situación actual y perspectivas. Actas Dermosifiliogr. 2007;98(8):556–62.PubMedCrossRefGoogle Scholar
  58. 58.
    Graaf YGL, Euvrard S, Bavinck JNB. Systemic and topical retinoids in the management of skin cancer in organ transplant recipients. Dermatol Surg. 2004;30:656–61.PubMedCrossRefGoogle Scholar
  59. 59.
    Marshall J. Treatment of solar keratoses with topically applied cytostatic agents. Br J Dermatol. 1968;80:540–2.PubMedCrossRefGoogle Scholar
  60. 60.
    Grimaitre M, Etienne A, Fathi M, Piletta PA, Saurat JH. Topical colchicine therapy for actinic keratoses. Dermatology. 2000;200:346–8.PubMedCrossRefGoogle Scholar
  61. 61.
    Akar A, BulentTastan H, Erbil H, Arca E, Kurumlu Z, Gur AR. Efficacy and safety assessment of 0.5 % and 1 % colchicine cream in the treatment of actinic keratoses. J Dermatolog Treat. 2001;12:199–203.PubMedCrossRefGoogle Scholar
  62. 62.
    Wolf P, Maier H, Müllegger R, Chadwick CA, Hofmann-Wellenhof R, Soyer HP, et al. Topical treatment with liposomes containing T4 endonuclease V protects human skin in vivo from ultraviolet-induced upregulation of interleukin-10 and tumor necrosis factor-α. J Invest Dermatol. 2000;114:149–56.PubMedCrossRefGoogle Scholar
  63. 63.
    Zahid S, Brownell I. Repairing DNA damage in xeroderma pigmentosum: T4N5 lotion and gene therapy. J Drugs Dermatol. 2008;7(4):405–8.PubMedGoogle Scholar
  64. 64.
    Szeimies RM, Bichel J, Ortonne JP, et al. A phase II dose-ranging study of topical resiquimod to treat actinic keratosis. Br J Dermatol. 2008;159(1):205–10.PubMedCrossRefGoogle Scholar
  65. 65.
    Ogbourne SM, Suhrbier A, Jones B, et al. Antitumor activity of 3-ingenyl angelate: plasma membrane and mitochondrial disruption and necrotic cell death. Cancer Res. 2004;64(8):2833–9.PubMedCrossRefGoogle Scholar
  66. 66.
    Siller G, Gebauer K, Welburn P, et al. PEP005 (ingenol mebutate) gel, a novel agent for the treatment of actinic keratosis: results of a randomized, double-blind, vehicle-controlled, multicentre, phase IIa study. Australas J Dermatol. 2009;50(1):16–22.PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  1. 1.Dermatologic Surgery and Cutaneous Oncology Section, Department of DermatologyHospital Militar “Dr. Carlos Arvelo”CaracasVenezuela

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