| Abstract |
62 yo man with SCIN of finger. Failed Imiquimod and responded
to combination of 5% 5FU + Imiquimod |
Patient |
62-year-old man |
Duration |
15 years |
Distribution |
Left index finder |
| History |
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.
|
| Images |
|
| Laboratory Data |
|
|
Histopathology |
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
|
| References |
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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