Tumors of the skin. XII. Topical 5‐fluorouracil for epidermal neoplasms

Abstract

Our studies have been carried out in over 500 patients with an aggregate of more than 15,000 lesions for observation periods in excess of 5 years. Topical chemotherapy with 5-FU was shown to result in selective eradication of premalignant and superficial malignant lesions of the skin. Since the action of 5-FU is selective, it produces minimal or no effects on normal tissues adjacent to tumors. Healing therefore occurs with slight or no apparent scarring. Topical chemotherapy is indicated for solar keratoses and other precancerous lesions as well as for multiple superficial primary skin cancers when standard therapeutic measures are not suitable because large areas of the skin are involved by persistently developing tumors. Topical cancer chemotherapy induces the resolutionof premalignant skinlesions and prevents their further development to the malignant stage. Early primary skin cancers and premalignant lesions react to topical antitumor agents before they are otherwise clinically detectable. These tumors can therefore be eradicated before they present significant clinical problems. Early detection and eradication of skin cancers and premalignant skin lesions furthermore result in the reduction of the subsequent incidence of clinically significant tumors. Local chemotherapy therefore appears to have prophylactic value. Local administration of 5-FU results in high concentrations of the antitumor agent at the tumor site, although the total amount administered and the rate of absorption are relatively low. General toxicity such as bone marrow depression and other systemic side-effects are therefore not encountered with local cancer chemotherapy. Superficially located neoplasms are suitable model systems for the study of tumor biology. Local chemotherapy indicates that differential and selective chemical effects can be produced in neoplastic cells and their normal counterparts. Studies on local chemotherapy demonstrate that the selective eradication of malignant disease in many by chemical means is feasible.

Basal cell naevus syndrome: an update on genetics and treatment

“…Moreover, while they have high cure rates for single lesions, cure rates are much lower for extensive or multiple lesions. Edmund Klein, the father of immunotherapy and topical chemotherapy, pioneered the use of 5‐fluorouracil in patients with BCNS, although it may not be of value in every patient . While imiquimod as a single treatment has shown limited success, it may be used as an adjuvant to Mohs micrographic surgery, curettage and excision …”

“…Edmund Klein, the father of immunotherapy and topical chemotherapy, pioneered the use of 5-fluorouracil in patients with BCNS, although it may not be of value in every patient. 43,44 While imiquimod as a single treatment has shown limited success, it may be used as an adjuvant to Mohs micrographic surgery, curettage and excision. 45 Capecitabine, an oral prodrug of 5-fluorouracil, is approved by the US Food and Drug Administration (FDA) for treatment of metastatic breast cancer resistant to other drugs.…”

Therapeutic Evaluation of Intralesional 5% 5‐Fluorouracil in Condyloma Acuminata

“…5‐fluorouracil emerged as a new class of tumor‐inhibiting compounds in 1957 (36). During the 1960s, Klein and others studied the topical administration of 5‐FU and other cytostatic agents for the management of precancerous lesions and superficially invasive neoplasms arising in the skin and mucous membranes (37). 5‐FU has been used as an antiproliferative agent in topical form for many years to treat urethral, penile, vaginal, vulval, and anal condyloma acuminata (38–40).…”

Solar cheilosis: An ominous precursor

“…[66][67][68] It may also be useful in patients with thin early SCC. 69 5-FU administration on the lips may have marked local side effects, including painful ulceration of the mucosal surfaces of the lips, intense erythema, and edema.…”