Imiquimod + 5 FU

presented by

David J Elpern MD

Williamstown, Massachusetts, USA

January 7, 2007

Abstract 62 yo man with SCIN of finger. Failed Imiquimod and responded to combination of 5% 5FU + Imiquimod
62-year-old man
15 years
Left index finder

This 62 yo man had a 15 year history of a plaque on his left index finger. He had been told it was a wart in the past.

Physical Examination
2.0 cm in diameter verrucous plaque.



Laboratory Data



Because of long history a biopsy was done to r/o SCC. The path showed in situ squamous cell carcinoma

Diagnosis Squamous Cell Carcinoma in-situ
Reasons Presented

We discussed micrographic surgery vs. topical chemotherapy and he elected the latter. After two weeks of nightly imiquimod there was no reaction. I then added 5% 5FU cream as described in a recent article. Within two weeks the area was ulcerated and painful. The treatment was stopped and he will have a repeat biopsy to test for cure in 2 - 3 months.

Questions and Teaching Points

The combination of 5FU and imiquimod is interesting and will be a therapeutic advance, but like imiquimod, it will take some time to master the "Art." I was surprised at the intensity of this reaction. I suspect he may have done better if I used the 5FU three times a week. Your comments are welcome


Ondo AL, Mings SM, Pestak RM, Shanler SD. Topical combination therapy for cutaneous squamous cell carcinoma in situ with5-fluorouracil cream and imiquimod cream in patients who have failed topical monotherapy.J Am Acad Dermatol. 2006 Dec;55(6):1092-4.

Topical therapeutic options for cutaneous squamous cell carcinoma in situ include 5-fluorouracil cream and imiquimod cream. Such treatment may be preferable to surgical or destructive modalities in certain anatomic locations and in instances where patients are unwilling or poor surgical candidates. We present 4 such patients with cutaneous squamous cell carcinoma in situ involving a digit. Each patient failed treatment with imiquimod cream as monotherapy. In addition, two patients failed treatment with 5-fluorouracil cream as monotherapy. All 4 responded completely to 5-fluorouracil and imiquimod cream as combination therapy. In patients who have failed monotherapy with a topical agent for cutaneous squamous cell carcinoma in situ, combination treatment using both topical 5-fluorouracil cream and imiquimod cream may be considered as an alternative therapeutic strategy.

Keywords squamous cell carcinoma in situ, 5 FU, imiquimod
Comments from Faculty and Members

Omid Zalgari MD, Rasht, Iran on January 8, 2007

It looks like Bowen. I've not read the paper you mentioned yet, but in my limited experience with Imiquimod, it works better when you elicit some sort of inflammation on the lesions. In this case, it seems that 5-FU does this job great! Thanks for sharing the case.

Thamir Alkubaisi MD, Baghdad, Iraq, on January 9, 2007

A nice case, but he was late (15 years). Bowen's disease has a sharp defined border with scale and crust, slowly enlarges, affects mostly older white men on sun exposed surfaces. On histopathology, there is an intraepadermal squamous cell carcinoma. 5% of case may complicate to squamous cell carcinoma.
5-FU cream twice daily for 4-8 weeks (with or without occlusion) is a good choice, and there is other mode of non invasive procedure as photodynamic therapy is helpful.

Khaled El-hoshy M.D., Troy, Michigan, USA on January 9, 2007

A good option for such a case is Radiotherapy. I would definitely use it should a recurrence occur down the road.

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