Indian Journal of Drugs in Dermatology

CASE REPORT
Year
: 2022  |  Volume : 8  |  Issue : 1  |  Page : 29--31

Topical 5-fluorouracil for Basal Cell Carcinoma


Anil Balkrishna Bhokare 
 Apex skin clinic, Malegaon, Dist-Nashik, Maharashtra, India

Correspondence Address:
Anil Balkrishna Bhokare
Apex skin clinic, Malegaon, Dist-Nashik 423203, Maharashtra
India

Abstract

Basal cell carcinoma is a malignant epithelial tumor arising only in skin, from the basal layer of the epidermis or of the pilosebaceous adnexa. Diagnosis often depends on skin examination, confirmed by tissue biopsy. Treatment is typically by surgical removal. This can be by simple excision if the cancer is small; otherwise Mohs surgery is generally recommended. Other options may include topical chemotherapy, laser therapy, or the use of imiquimod. In this study, we conclude topical 5-fluorouracil is a highly effective and well-tolerated treatment option for superficial basal cell carcinomas.



How to cite this article:
Bhokare AB. Topical 5-fluorouracil for Basal Cell Carcinoma.Indian J Drugs Dermatol 2022;8:29-31


How to cite this URL:
Bhokare AB. Topical 5-fluorouracil for Basal Cell Carcinoma. Indian J Drugs Dermatol [serial online] 2022 [cited 2022 Oct 6 ];8:29-31
Available from: https://www.ijdd.in/text.asp?2022/8/1/29/347285


Full Text



 Key Messages:



Five percent 5-FU is a highly effective and well-tolerated treatment option for superficial basal cell carcinomas offering a generally good cosmetic outcome and high levels of patient satisfaction.

 Introduction



Five percent 5-fluorouracil (5-FU) cream is approved by the FDA for the treatment of superficial basal cell carcinomas but has been underutilized. In certain situations, successful topical therapy of basal cell carcinoma (BCC) without the inconvenience, risk, and expense of surgery would be of great value to patients. Five percent 5-FU is a highly effective and well-tolerated treatment option for superficial basal cell carcinomas offering a generally good cosmetic outcome and high levels of patient satisfaction. For the similar reason, we explored utility of topical 5-FU cream in the treatment of basal cell carcinoma with acceptable results without warranting the invasive surgical procedures.

 Case History



Case reports

A total of 5 patients of basal cell carcinoma were given topical 5-fluorouracil and were followed for evaluation at our center based in rural Mahararashtra. All patients were selected after histological confirmation except one patient who was not willing for skin biopsy but was diagnosed on clinical ground. [Figure 1]a and [Figure 2]a Basic demographic details and clinical description of morphology or presenting features are given in the following table. [Table 1] All patients were old age and were either not affordable or nor willing for surgical management. Case 1 was having superficial ulcerative type of basal cell carcinoma and case 2, 4 and 5 were superficial spreading type of BCC and case 3 was diagnosed as pigmented variety of BCC. 5-fluorouracil in the form of 5% preparation was used. All subjects were advised to apply the cream at night over the lesion and on 5 mm normal skin surrounding it. First follow up was done after a week and thereafter every two-weekly follow up were done. Initially all patient complaints of irritation which was managed by advising to reduce the contact period and gradually increase it as per the tolerance of an individual patient. One patient developed skin ulcer and was treated with a short course of topical antibiotics (Mupirocin ointment) and then was restarted with 5-fluorouracil with further observation and caution. Clearance of pigmented/ulcerated patch with an absence of induration was considered as the end point of treatment. All patients were followed up to 6 months. All 5 patients showed complete clinical cure [Figure 1]b & [Figure 2]b. Average clinical cure time interval was 12–16 weeks.{Figure 1} {Figure 2} {Table 1}

 Discussion



Basal-cell carcinoma (BCC), also known as basal-cell cancer, is the most common type of skin cancer. It often appears as a painless raised area of skin, which may be shiny with small blood vessels running over it; or it may present as a raised area with ulceration. Basal-cell cancer grows slowly and can damage the tissue around it but is unlikely to spread to distant areas or to result in death. Fair skin, ultraviolet light, radiation therapy, arsenic, exposure, poor immune system² are majorrisk factors. UV light during childhood is particularly harmful. Tanning beds have become another common source of ultraviolet radiation. Clinical examination, site of lesion and histopathological study helps to confirm the diagnosis. Treatment is typically by surgical removal is the main line of treatment which may be simple excision or Mohs surgery². Few studies with topical treatments like chemotherapy, imiquimod and lasers are present. In the rare cases in which distant spread has occurred, chemotherapy or targeted therapy may be used.³

Fluorouracil is an antimetabolite fluropyrimidine analog of the nucleoside pyrimidine with antineoplastic activity. Fluorouracil and its metabolites possess a number of different mechanisms of action. In vivo, fluorouracil is converted to the active metabolite 5-fluoroxyuridine monophosphate (F-UMP); replacing uracil, F-UMP incorporates into RNA and inhibits RNA processing, thereby inhibiting cell growth. Another active metabolite, 5-5-fluoro-2’-deoxyuridine-5’-O-monophosphate (F-dUMP), inhibits thymidylate synthase, resulting in the depletion of thymidine triphosphate (TTP), one of the four nucleotide triphosphates used in the in vivo synthesis of DNA. Other fluorouracil metabolites incorporate into both RNA and DNA; incorporation into RNA results in major effects on both RNA processing and functions. 5-FU if prepared with phosphotidyl choline as a vehicle can penetrate into epidermis and results can be improved up to 90% as compared with petrolatum base 57%. Topical 5-FU was generally well tolerated with a good cosmetic outcome. The majority of patients had no pain or scarring except mild erythema, irritation and ulceration initially. Irritation and ulceration were managed by withholding the topical 5-FU. Patients were very satisfied with the outcome. Those having superficial lesions responded fast around 12–14 weeks as compare to ulcerative type took approximately 16–20 weeks for cure.

We explored use of topical 5-FU in basal cell carcinoma with good effects and better safety in our 5 patients. More randomized controlled studies are needed to confirm safety and efficacy of topical 5-FU in the treatment of basal cell carcinoma especially in individuals who do not wish to undego invasive surgical procedures. Also histological follow up or posttreatment skin biopsies are required to know exact histologic clearance of the disease.

To conclude, five percent 5-FU is a highly effective and well-tolerated treatment option for superficial basal cell carcinomas offering a generally good cosmetic outcome and high levels of patient satisfaction.[3]

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1Gross K, Kircik L, Kricorian G 5% 5-fluorouracil cream for the treatment of small superficial basal cell carcinoma: Efficacy, tolerability, cosmetic outcome, and patient satisfaction. Dermatol Surg 2007;33:433-9; discussion 440.
2Lee S, Selva D, Huilgol SC, Goldberg RA, Leibovitch I. Pharmacological treatments for Basal Cell carcinoma. Dermatol Surg 2000;26:338-40.
3Telfer NR, Colver GB, Morton CA; British Association of Dermatologists. Guidelines for the management of basal cell carcinoma. Br J Dermatol 2008;159:35-48.