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- Presentation
Localized Non-Surgical Treatments for Keratinocyte Carcinoma
Description
The talk focuses on the decision-making process for non-surgical treatments of localized keratinocyte carcinoma, particularly in elderly patients. A case is presented of a 92-year-old woman with squamous cell carcinoma (SCC) on the nose. The speaker discusses the effectiveness and potential complications of Mohs surgery, emphasizing its high cure rate but also the risk of significant scarring and other surgical side effects. It is suggested that Mohs surgery is appropriate when non-surgical treatments have failed or when the clinical presentation does not match the biopsy results. Non-surgical treatments include topical therapies like 5-fluorouracil and imiquimod, which vary in efficacy and have side effects akin to a bad sunburn. Photodynamic therapy (PDT) is highlighted as having good cosmetic outcomes and a high satisfaction rate among patients. The speaker notes that treatment decisions also depend on factors such as the patient's overall health, immunosuppressive status, and lesion location. For patients with multiple squamous cell lesions, particularly on the legs, injections of 5-fluorouracil can yield significant resolution rates. Overall, the speaker advocates for a tailored treatment plan that balances patient preference, the lesion's characteristics, and the risks associated with various therapies.
View moreConclusions
- Consider Mohs surgery for superficial or in situ skin cancers when there is evidence of deeper invasion or treatment failure with non-surgical approaches.
- Non-surgical treatments can be effective for superficial squamous cell carcinoma and superficial basal cell carcinoma, especially in cases with significant actinic damage or comorbidities.
- Topical therapies like 5-fluorouracil and imiquimod provide a range of cure rates but may not be FDA approved for SCC in situ specifically.
- Patient characteristics such as age, comorbidities, and treatment history significantly influence the decision between surgical and non-surgical treatment.
- There can be benefits to using non-surgical methods, especially for patients who prioritize avoiding surgery due to potential complications and recovery time.
- Monitoring patients after topical treatment is essential, typically within 3-4 months to evaluate effectiveness.
- Eruptive squamous atypia may require specific management, including injections of 5-fluorouracil, and highlights the importance of a multidisciplinary approach to treatment logistics.
- Que, K., et al., 2019, JAAD