Topical 5% 5-fluorouracil in the treatment of multifocal basal cell carcinoma of the face: A novel chemotherapeutic approach

Abstract

To determine the safety and efficacy of topical 5-fluorouracil (5-FU) 5% ointment in treatment of non-syndromic multifocal basal cell carcinoma. A 55-year-old male patient, with 8 hours of daily sun exposure, having histologically proven and radiologically non-syndromic, multifocal basal cell carcinoma with involvement of 6 sites on the face, was treated with topical 5-FU 5% ointment twice daily over all sites except the site involving lid margin to prevent corneal toxicity. Left lid lesion underwent wide surgical excision with 5-mm clear margins and reconstruction with nasal septal mucoperichondrium and local skin mobilization. Pharmacologic effects first appeared at 4 weeks and by 8 weeks, the lesions had scabbed and had fallen off with no induration but residual mild perilesional erythema. Patient had post-op histopathological clear margins and recovered uneventfully. No recurrence in 6 months. A topical 5-FU 5% ointment represents a paradigm shift in the treatment of BCC from invasive and disfiguring options (surgery and chemoradiotherapy) to cheap, convenient, effective, non-invasive, non-disfiguring topical chemotherapy. Topical 5% 5-FU is a safe and effective modality of treatment of superficial spreading multifocal basal carcinoma, especially lesions larger than 10 mm, where margins cannot be identified clearly and recurrent lesions.

Topical 5‐fluorouracil in dermatologic disease

“…Another case report described a male with biopsy‐proven multifocal BCC of the face treated with topical 5% 5‐FU cream twice daily for 12 weeks. At the end of treatment, biopsies showed histopathologically clear specimens after treatment, and there was no evidence of clinical recurrence at 6 months …”

“…At the end of treatment, biopsies showed histopathologically clear specimens after treatment, and there was no evidence of clinical recurrence at 6 months. 37 Malignant melanoma Topical 5-FU-imiquimod dual therapy may be a promising nonsurgical alternative for controlling local growth of melanoma cutaneous metastases. A case series (n = 5) examined the efficacy of topical 5% 5-FU and 5% imiquimod combination therapy in the treatment of malignant melanoma skin metastases (total of 45 lesions).…”

Pilot Study on High-Intensity Focused Ultrasound (HIFU) for Basal Cell Carcinoma: Effectiveness and Safety

“…Consequently, there is a growing interest in exploring and developing non-surgical alternatives that can offer equally effective outcomes with minimal aesthetic impact. These non-surgical options include destructive techniques (like curettage alone, cryosurgery, or electrodesiccation), photodynamic therapy, topical drugs (such as 5-fluorouracil, imiquimod, ingenol mebutate), radiotherapy, and hedgehog pathway inhibitors [ 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. When choosing between these options, considerations include the location, tumor size, histopathological subtype, recurrence, and patient preference [ 16 ].…”

Comprehensive treatment of basal cell carcinoma in nevoid basal cell carcinoma syndrome with 5‐fluorouracil and salicylic acid

“…4 Considering patient compliance and the severity of BCC, we chose to perform SA chemical resurfacing on an outpatient basis rather than the daily use of 10% SA solution. Overall, 5FU-SA treatment is an option for AK, 5,6 SCC, and BCC, 7 even in resistant cases of filiform facial warts. 8 The BCCs in NBCCS rarely metastasize but can lead to the deformation or destruction of local tissue and organs, hence, BCCs should be diagnosed and treated at an early stage.…”