The patient is a 64 yo man who received a renal transplant x years ago and is maintained on prednisone and Prograf. He presented with a 4 cm biopsy proven superficial squamous cell carcinoma on the left parietal scalp. This lesion would have necessitated a large micrographic surgical procedure with a graft.
An attempt was made to treat with topical chemotherapy. Imiquimod was inititiated, but there was only minimal response after two weeks. Five fluorouracil was then added and this achieved a moderate response. The combination of imiquimod/5FU was continued for a total of six weeks, then stopped. One month later there appears to be a clinical cure. He will be followed closely.
There is a possibility that this combination therapy can help selected transplant patients with low risk superficial nonmelanoma skin cancers.
Clinical Photos:
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| After Six Weeks Imiquimod/5FU |
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| One month after Stopping Imiquimod/5FU |
Comment: This treatment made me a little nervous, but the surgical approach would have been major for a lesion that had only a small chance of of metastasizing. The benefits and risks were discussed with the patient; however, his oncologist was unhappy about this approach.
From Jenny Stone, Mohs surgeon: I think you did this fellow a favor. If you can get topical therapies to work for superficial NMSC's, esp in an area difficult to repair after loss of full thickness skin, such as scalp, more power to you. Topical 5 FU has been used occlusively (sometimes under Unna boot dressings) to area involved in field effect sup SCC's (like hand) and that especially is helpful for the immunosuppressed. Patients s/p organ transplants are so prone to multiple SCC's that anything that spares tissue is welcome. Let the oncologist bluster. I have chased many superficial tumors with Mohs in my career and the use of topicals is very helpful in many situations to avoid excessive tissue loss.
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