Extract
Imiquimod and superficial skin cancers.
Abstract
Topical imiquimod has opened an entirely new area of dermatology that previously did not exist: medical therapy for skin cancers. While surgery will continue to play a vital role in treating more aggressive tumors and in patients who may not be imiquimod candidates, the availability of a viable medical therapy that can be used independently or in combination with other modalities will considerably enhance our ability to treat skin cancer successfully. The History of Medical Treatment for Skin Cancers: Fluorouracil and Imiquimod The idea of medical treatment for skin cancer is a relatively new one in dermatology. Although fluorouracil has been FDA approved for the treatment of basal cell carcinomas for many years, it is rarely used as primary therapy because of its high failure rate. Furthermore, recurrences tend to be deep and large rather than superficial and peripheral as typically seen in cancers that recur after most ablative techniques. (1) As seen in Figure 1, topical fluorouracil has not become a truly viable alternative to surgery for skin cancers secondary to a depth-concentration problem. Fluorouracil is a cytotoxic drug that kills tumor cells in a concentration-dependent fashion; therefore, it must reach an effective concentration in every part of the tumor to eradicate the entire lesion. This is not a problem for the upper portions of the...See the full content of this document
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