Topical Treatments for Basal Cell Carcinoma and Actinic Keratosis in the United States

Abstract

Skin cancer is an overarching label used to classify a variety of cutaneous malignancies. Surgical excision procedures are the commonly used treatments for these lesions; however, the choice to perform operative intervention may be influenced by other factors. Established research and literature suggest that topical treatments limit the need for surgical intervention and its commonly associated adverse effects, including infection and scarring. In addition, the growing indications for the usage of topical therapies in BCC treatment, as well as their increased availability and therapeutic options, allow for their greater applicability in the dermatology clinic. Certain topical therapies have been highlighted in research, especially those targeting basal cell carcinoma (BCC) and actinic keratosis (AK). There is also a clear correlation between cost and treatment outcomes, considering BCC’s ever-growing prevalence and the proportion of excised lesions being reported as malignant. This review will discuss BCC and AK lesion criteria that result in the most successful outcomes using topical treatments, then highlight the various topical treatment options, and finally address their clinical significance moving forward.

Topical and Intralesional Immunotherapy for the Management of Basal Cell Carcinoma

“…Side effects associated with 5-FU cream are similar to those observed with imiquimod cream, with the severity and occurrence varying among patients and depending on their compliance with treatment. These side effects include local reactions such as pain, itching, a burning sensation, erythema, alterations in skin pigmentation, crusting, and even blister development, while systemic reactions are less common [ 18 , 19 , 20 ].…”

“…While 5-FU exhibits higher recurrence rates at 3 and 5 years, similar cosmetic outcomes and a slight reduction in side effects have been observed. There is a slight decrease in pain and local reactions, as well as fewer flu-like systemic reactions, compared to imiquimod [ 6 , 12 , 18 , 20 , 21 ]. Conversely, 5-FU cream appears to be superior to photodynamic therapy (PDT) in terms of the risk of recurrences at 3 and 5 years of follow-up, with no differences in aesthetic outcomes and less pain during treatment [ 12 , 21 ].…”

“…Local and transient effects such as edema, erosion, and necrosis are the most common side effects observed, while systemic effects (cytopenias and gastrointestinal disturbances) are rare. Clinical trials aimed at evaluating the safety and efficacy of intralesional 5-FU to regulate dosage and obtain approval are currently in the recruitment phase (NCT06150144) [ 12 , 18 , 22 , 23 ].…”

“…Vascular tumor alteration has also been observed during this stage. Subsequently, within days, this destruction triggers a protein-kinase-dependent immune response that attracts neutrophils, leading to an increase in the antitumoral response through antibody production, along with Toll-like receptor signaling [ 17 , 18 , 31 ].…”

Unveiling the potential of photodynamic therapy with nanocarriers as a compelling therapeutic approach for skin cancer treatment: current explorations and insights

“… 49,50 In the context of PDT, topical application of photosensitizers allows for precise targeting of malignant cells while sparing healthy tissue, making it an attractive option for superficial skin cancers like basal cell carcinoma and actinic keratosis. 51,52 When combined with nanocarriers, the treatment strategy becomes superior as the delivery of photosensitizers gets optimized. Inadequate tissue penetration poses challenges to PDT effectiveness, which nanocarriers address by encapsulating photosensitizers, ensuring their stability, and facilitating active targeting of cancerous cells.…”