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Current treatment practices in non-melanoma skin cancer

Peris, K.

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doi: 10.1097/01.cmr.0000382798.06957.57
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The standard treatment of basal cell carcinoma (BCC) and squamous cell carcinoma (SCC) are surgical excision and Mohs micrographic surgery. In addition, curettage and electrodessication, cryosurgery and CO2 laser can be used in actinic keratosis (AK) and small, low-risk BCC. Radiotherapy is recommended for treatment of large BCC or SCC in older patients. A medical treatment including 5-FU, photodynamic therapy (PDT), intralesional bleomicin or IFNα, topical imiquimod, diclofenac and tazarotene can be used in selected AK or BCC.

Imiquimod is an immune response modifier that shows anti-tumoral and antiviral activity through stimulation of both innate and acquired immunity and direct proapoptotic activity. Several studies reported a complete clinical regression after imiquimod treatment in up to 90% of AKs and in situ SCC, in 69%–100% of superficial BCCs and in approximately 50% of nodular BCCs. Similarly, PDT, which is based on the topical application of a photosensitizing agent (ALA o MAL) and its activation by light irradiation, showed a good efficacy and safety profile in the treatment of AK, Bowen disease, nodular and superficial BCCs achieving response rate of 75%, 90%, 85%–92% and 73%–91%, respectively. Recent clinical trial demonstrated a role for a diterpene extract from Euphorbia peplus (ingenol mebutate) gel in the treatment of AK. Finally, there is a growing number of pathogenesis-targeted therapies such as hedgehog pathway-inhibitors for the treatment of BCC. Therefore the wide spectrum of commercially available therapies, the possibility of combined or sequential treatments, the development of new therapies targeting the pathogenetic mechanisms of NMSC, provide a promising perspective not only in terms of clinical benefit and safety but also in terms of patients’ compliance and quality of life.

© 2010 Lippincott Williams & Wilkins, Inc.