Please login or create an account. If you do not have access to this content, you will be shown a 30 second preview and licensing options.
- Presentation
Topical and Intralesional Treatments for Actinic Keratoses and Squamous Cell Carcinoma in Healthy and Organ Transplant Patients
Description
The talk reviewed topical and intralesional treatments for actinic keratoses (AKs) and squamous cell carcinoma (SCC) in healthy patients and solid organ transplant recipients, using an elderly renal transplant patient with extensive sun damage and residual SCC in situ as a case example. In healthy patients, 5-fluorouracil (5-FU) for 2 to 4 weeks is effective for AKs, and the 5-FU/calcipotriene combination can improve clearance and compliance with very short courses. In transplant patients, evidence suggests photodynamic therapy (PDT) may outperform 5-FU, imiquimod, diclofenac, and ablative laser for AK field therapy, while topical imiquimod appears safe and can clear lesions in some patients. For superficial skin cancers, studies support short-course 5-FU/calcipotriene and alternating imiquimod with 5-FU, including in immunosuppressed patients, with high clearance rates and low recurrence in reported series. The speaker also noted that transplant status predicts a higher risk of occult invasion in SCC in situ, supporting close surveillance. For invasive SCC, intralesional 5-FU has shown strong clearance in both healthy and transplant patients and appears superior to intralesional methotrexate. Overall, the talk emphasized that treatment choice should consider immune status, lesion type, anatomic site, and patient tolerance, and highlighted ongoing research into optimized 5-FU/calcipotriene regimens for transplant recipients.
View moreConclusions
- In healthy patients, topical 5-fluorouracil remains a highly effective field treatment for actinic keratoses, and shorter combination regimens can improve adherence while preserving efficacy.
- In solid organ transplant recipients, photodynamic therapy appears to be the strongest supported field therapy for actinic keratoses, although alternative topical regimens may still have a role.
- Imiquimod can be used safely in transplant patients, but its efficacy for actinic keratoses is variable and may be less robust than PDT or optimized 5-FU-based approaches.
- The benefit of 5-fluorouracil plus calcipotriene seems to depend partly on an intact immune response, suggesting immunosuppressed patients may need longer or modified treatment courses.
- For superficial keratinocytic carcinomas, topical 5-fluorouracil plus calcipotriene shows high clearance rates in both immunocompetent and immunosuppressed patients.
- Organ transplant recipients with SCC in situ are at meaningful risk of occult invasion or tumor upstaging, supporting caution when choosing non-surgical management.
- Intralesional 5-fluorouracil appears to be a highly effective nonsurgical option for low-risk invasive squamous cell carcinomas, including in transplant recipients.
- Across the available evidence, intralesional 5-fluorouracil generally outperforms intralesional methotrexate for clearance and requires fewer treatments.
- Overall, nonsurgical therapies can be effective for field cancerization and selected superficial or low-risk invasive skin cancers, but treatment choice should be individualized to immune status, anatomic site, and tumor risk.
- Network meta-analysis of the outcome ‘participant complete clearance’ in nonimmunosuppressed participants of eight interventions for actinic keratosis: a follow-up on a Cochrane review. British Journal of Dermatology.#10.1111/bjd.12343
- Randomized trial of calcipotriol combined with 5-fluorouracil for skin cancer precursor immunotherapy. The Journal of Clinical Investigation.#10.1172/jci89820
- Topical immunomodulation under systemic immunosuppression: results of a multicentre, randomized, placebo-controlled safety and efficacy study of imiquimod 5% cream for the treatment of actinic keratoses in kidney, heart, and liver transplant patients.#10.1111/j.1365-2133.2007.08269.x
- Treatment of post-transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy. DOI: 10.1111/j.1365-2133.2006.07616.x#10.1111/j.1365-2133.2006.07616.x
- Topical treatment of actinic keratoses in organ transplant recipients: a feasibility study for SPOT. British Journal of Dermatology.
- Photodynamic therapy for basal cell carcinomas in organ-transplant recipients.#10.1111/j.1365-2230.2011.04248.x
- Combined topical 5-fluorouracil and calcipotriene effectively treats superficial keratinocyte carcinomas: A retrospective cohort study from 2 academic centers.#10.1016/j.jaad.2024.10.074
- Intralesional methotrexate versus 5-fluorouracil in the treatment of keratoacanthoma. Archives of Dermatological Research (2024) 316:400.#10.1007/s00403-024-03139-1