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  • Presentation

F109 - Side Effects May Include: Illustrative Cases of Dermatologic Adverse Events

Description

Molly Moy, a MOS surgeon, discusses dermatalogic adverse events linked to commonly used antineoplastic agents, particularly concerning older adults. She focuses on intralesional therapies for squamous cell carcinoma and topical therapies for actinic keratoses. Through illustrative case studies, she emphasizes the importance of side effects management when treating elderly patients with intralesional methotrexate and fluorouracil, highlighting common adverse effects such as pain, hyperpigmentation, and ulceration. The need for careful monitoring of patients, especially those with compromised renal function, is underscored, emphasizing that intralesional methotrexate can lead to serious complications. She explores alternatives like weekly fluorouracil injections and discusses patient responses, pain management strategies, and the need for clear communication regarding potential outcomes and side effects. The presentation also includes perspectives on the use of vismodegib for advanced basal cell carcinoma and its side effects, encouraging the exploration of drug holidays to mitigate adverse reactions. Moy's approach stresses the importance of personalized treatment for older adults and the use of supportive therapies, including lifestyle modifications, to enhance patient care and satisfaction.

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Conclusions

  • Kidney function is the most critical factor when deciding on treatments with intralesional methotrexate or fluorouracil.
  • Both intralesional methotrexate and fluorouracil have serious potential side effects that need careful consideration, especially in older patients.
  • Patients on dialysis should not receive methotrexate due to the risk of severe complications like pancytopenia.
  • Hyperpigmentation is a common side effect of intralesional fluorouracil therapy, which can be transient.
  • Oncology practitioners should manage patient expectations regarding aesthetic outcomes, particularly after fluorouracil treatment.
  • When treating actinic keratosis larger than 2 cm, surgical intervention may be the better course of action rather than relying solely on intralesional therapies.
  • Increased frequency or volume of injections for fluorouracil can lead to an increased pain response or ulceration, particularly in patients with peripheral vascular diseases.
  • Vismodegib may pose an increased risk for developing squamous cell carcinoma in patients treated for basal cell carcinoma, though findings are still debated.
  • Systemic toxicity is not usually reported with fluorouracil, making it preferred over methotrexate for certain patients.
  • Alternative dosing schedules for vismodegib can help manage side effects like muscle cramps, which are common in treatment.
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