unding skin.
Topical Chemotherapy Agents
These treat both visible and invisible lesions with minimal risk of scarring. Common topical agents include Imiquimod and Fluorouracil. Imiquimod is called a biologic agent because it turns up the patient’s own immune system to fight off the cancer and pre-cancer cells. Imiquimod was first introduced to treat skin cancers in the late 1990’s. Imiquimod treats both actinic keratosis and superficial basal cell skin cancer and superficial squamous cell skin cancer. The cure rates for this treatment are not as high as excisions or MOHS surgery, though. Fluorouracil is a chemotherapy treatment that targets cancer cells and kills them. Fluorouracil has been around for decades and is very useful for treating pre-skin cancers.
Pre-cancers and cancerous lesions of the skin are usually treated with either surgical methods or liquid nitrogen. A topical cream, Imiquimod, has been on the mark for over 15 years to treat these lesions. Imiquimod is a cream that when applied to the precancerous lesions, increases the body’s own immune system to fight the abnormal cells. This process provides you a non-surgical option to treat the cancer and/or pre-cancerous cells. Imiquimod cream is FDA approved to treat superficial Basal Cell Carcinoma, Actinic keratosis, as well as squamous cell carcinoma and even malignant melanomas.
Treatment for pre-cancers (actinic keratosis) may be 6 – 8 weeks and 12-16 weeks for basal cell skin cancer.
Application instruction Note – packets are very tiny and may be used multiple times.
- Open the packet with scissors or a simple pinhole. Gently squeeze the pouch and with a toothpick, remove a tiny amount of cream to cover the area you wish to treat.
- Place the small amount of cream on the center of the area to treat.
- Do NOT spread the cream to the surrounding tissue as this may cause unnecessary irritation.
- Apply the Imiquimod cream three times a week to start – usually Monday, Wednesday and Friday. Stop application when a rash or redness develops at the site of application. Wait for 10 days until the redness or rash clears, then restart the Imiquimod cream. Continue starting and stopping the Imiquimod as directed for a total of 12 weeks.
After each application fold the packet over and store it in a plastic baggy. Ignore the “single application” labeling.
Imiquimod Treatment Reactions
After 2-4 applications the skin may become red and scaly, heaped up and crusty or weepy and crusty. This is an anticipated side effect. If your skin becomes too irritated from the product, stop product application and apply Polysporin or Bacitracin 2-3 times a day for 3-4 days after soaking the crusts with some plain warm water for 5 minutes. Once the reaction response has been minimized, begin with the Imiquimod again but less frequently, maybe once or twice a week. I f no reaction occurs, increase to 5 days for a week, then daily for a week. Some people do not react at all. On occasion one can get a very big aggressive inflammatory reaction with extensive crusting. This response does fade after discontinuation of product and any residual skin changes will fade.
At the end of treatment the skin in the pre-cancerous areas usually looks smooth and soft. In the areas where you have had cancer it may be white and there may be some scarring. If the cancer was large enough to destroy tissue, there may be a depression left behind. It does take at least 3-4 months for color changes to blend with the rest of the skin and there may be areas of blotchy pigmentation where the color is just not quite even. The cosmetic results are generally better than surgery; however, further treatment may be needed for deeper lesions before using Imiquimod.
You can learn more about skin cancer & pre-cancer treatments at American Academy of Dermatology.