Treatment of keratoacanthomas with intralesional fluorouracil

Abstract

Fourteen patients with 26 keratoacanthomas (KA) were treated weekly with intralesional injections of fluorouracil. Twenty-five lesions cleared in an average of three weeks (range, two to eight weeks) after an average of 2.8 injections. One KA failed to respond after five weekly injections and was excised. No recurrences or meaningful side effects were observed. It appears that treatment of KA with intralesional fluorouracil injections is a safe, effective, and convenient mode ot treatment yielding excellent cosmetic results.

Aggressive Keratoacanthoma of the Eyelid: “Malignant” Keratoacanthoma or Squamous Cell Carcinoma?

“…We had no previous experience in treating keratoacanthomas with intralesional 5‐fluorouracil or radiotherapy, but based on the results with this case, we now believe that surgery is preferable, although it may have to be extensive. In keeping with the cases reported in the literature that were treated with intralesional 5‐fluorouracil 3 or radiotherapy, 4 the keratoacanthoma of our patient should have regressed on the therapy we provided. We have no explanation for the poor response of our patient.…”

Treatment of Cutaneous Neoplasms by Intralesional Injections of 5‐Fluorouracil (5‐FU)

“…5‐F luorouracil (5‐ fu ) has been used effectively by topical application in the management of some benign, premalignant, and malignant cutaneous neoplasms. Intralesional injection of the agent has recently been reported to be therapeutically effective in nodular basal‐cell epitheliomas and keratoacanthomas. We herewith report our experience and generally favorable results in the use of 5‐FU by intralesional deposition in the latter conditions.…”

“…Our experience is in agreement in that five injections were required in one patient and six injections in the other of the two we were successful with. Odom and Goette were able to eliminate keratoacanthomas with 2.8 injections in average, but the lesions we treated required an average of 8 injections of 5‐FU.…”

Relative Efficacy of Nonoperative Treatment of Keratoacanthomas

“…A total of 184 patients treated for KAs using either intralesional or topical therapies were identified across 40 studies. Of these, 1 study used intralesional bleomycin, 8 7 studies used intralesional 5-FU, 9,18 -23 and 15 studies used intralesional MTX (Table 1). 7,24 -37 Similarly, 5 studies used topical 5-FU 5,19,38 -40 and 12 studies used topical imiquimod (Table 2).…”

“…Several studies reported side effects of central necrosis of the KA; however, this is more likely a clinical indication that the treatment is performing as expected. 20,21 Beyond expected irritation: 2 patients applying topical 5-FU experienced acute pruritic contact dermatitis which resolved with discontinuation of treatment and administration of topical corticosteroids 5 ; several patients using topical imiquimod developed excessive erythema and crusting and required either a 1 week treatment hiatus or less frequent application 6,44,50 ; and 1 patient receiving intralesional 5-FU developed unexplained unilateral leg swelling following an injection of the shin. 20 This resolved without treatment in several days.…”