Consider tumor therapies

Chicago - Instead of taking the traditional surgical route for treating some non-melanoma skin cancers, consider some of the relatively newer medical therapies and the increasing body of evidence-based research supporting their use. According to Elbert Chen, M.D., medical treatment of some low-risk basal cell and squamous cell tumors provides a cost-effective, minimally or non-invasive option that dermatologists should consider.

In a presentation here at the American Academy of Dermatology's Academy '05, Dr. Chen reviewed literature that supports the use of new medical therapies for non-melanoma skin cancer (NMSC). Specifically, he highlighted imiquimod and mentioned photodynamic therapy.

Dr. Chen is a fellow in Mohs micrographic surgery and procedural dermatology at Columbia University in New York.

Despite these four areas of benefit listed below, Dr. Chen acknowledges that medical therapies have a lower efficacy than traditional surgical therapies for treatment of NMSC. The lack of long-term safety data for medical therapies is also a concern. However, medical therapies can be easier to tolerate and have cosmetic advantages.

"The current generation of medical therapies are not sufficiently efficacious to warrant their routine use for high-risk non-melanoma tumors," which are more difficult to treat and more likely to recur after treatment, he says.

"Although the incremental cost of surgery over an office visit is not high, when multiplied by the more than 1 million cancers each year, the cost becomes significant," Dr. Chen says.

"While surgical therapies are extremely effective, they have a higher direct cost."

However, "Given their recent introduction, there is no long-term safety data regarding their use," he says.

"Given the increasing prevalence of basal cell cancer and squamous cell cancer, there will certainly be patients who do not have ready access to a dermatologist. Medical therapies may offer an alternative," he says.

Two newer therapies

In his presentation, he highlighted two relatively new advances in medical therapies for NMSC: imiquimod and photodynamic therapy. He says a "critical mass of evidence has recently accumulated regarding their appropriate use" in NMSC.

While imiquimod itself is not new, Dr. Chen notes that it has only been one year since the U.S. Food and Drug Administration (FDA) approved its use to treat small superficial BCC of the trunk and extremities of patients with normal immune systems. The FDA approval was based on a study by Geisse and colleagues (Geisse et al. JAAD. 2004, 50; 722-733) which demonstrated 75 percent composite clearance and 82 percent histologic clearance after application five times per week for six weeks.