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- Presentation
Localized Non-Surgical Treatments for Keratinocyte Carcinoma
Description
Dr. Abigail Waldman discusses localized non-surgical treatments for keratinocyte carcinoma, specifically focusing on squamous cell carcinoma in situ and superficial basal cell carcinoma. She emphasizes that while Mohs surgery is effective with a high cure rate, it is not always the best option due to potential complications and the anxiety it causes patients. Non-surgical treatments are often suitable for elderly patients, those with significant actinic damage, or those at high risk of complications, such as bleeders or patients with dementia. Treatments include topical therapies like 5-fluorouracil and combination creams, with some promising results from studies showing high clearance rates. Image-guided superficial radiation therapy (SRT) is also a consideration, though it lacks the margin assessment benefits of Mohs surgery and may come with long-term cosmetic downsides. Dr. Waldman highlights the importance of individualizing treatment based on patient conditions and preferences. Lastly, she addresses the issue of eruptive squamous atypia in patients with a history of multiple Mohs surgeries, advocating for intralesional therapies such as 5-fluorouracil or methotrexate, which can effectively manage these reactive lesions.
View moreConclusions
- Localized non-surgical treatments for keratinocyte carcinoma can be effective, especially for low-risk superficial lesions.
- Mohs surgery is often preferred for certain cases due to its high cure rate but has associated complications.
- Non-surgical treatments may be advantageous for elderly patients or those with comorbidities who may not tolerate surgery well.
- Topical therapies such as 5-fluorouracil have varying cure rates based on lesion type and patient adherence.
- Combination creams, such as those containing 5-fluorouracil and calcipotriene, have demonstrated effectiveness in treating superficial skin cancers.
- Eruptive squamous atypia can be managed with intralesional therapy, with reasonable rates of complete resolution.
- Image-guided superficial radiation therapy offers a non-surgical option with a high cure rate but lacks the staging benefits of surgical approaches.
- Monitoring after treatment is essential to ensure the complete resolution of lesions and manage any recurrences effectively.
- > J Am Acad Dermatol. 2025 Mar;92(3):610-612. doi: 10.1016/j.jaad.2024.10.074.
- Que, K, et al, 2019, JAAD,
- Cho, JH, et al, 2024, Ann Dermatol.