Skin Cancer Treatment Options Topical
Skin Cancer Treatment Options Topical Topical drugs are drugs that are applied to the skin. Topical medicines for skin cancer and pre-drive come in the form of creams, gels, and liquid solutions. Four topical drugs are used to treat skin cancer and precursors: 1-8
- Fluorouracil (brand name: Carac, Efudex, Fluoroplex, Tolak)
- Imiquimod (brand name: Aldara, Zyclara)
- Diclofenac (brand name: Solaraze)
- Ingenol mebutate (brand name: Picato)
The recommended dosing frequency and duration of treatment varies with each topical drug.
What skin changes can be treated with topical medications?
Actinic keratoses. All four topical drugs can be used to treat actinic keratosis. Actinic keratosis is a kind of precursor, an abnormal patch of skin growth that can lead to cancer. While not all actinic keratoses become skin cancer, up to 10% of actinic keratoses become squamous cell carcinomas (SCC).9 In addition, 60 percent of SCC is produced by actinic keratoses.  For this reason, national cancer guidelines recommend the treatment of actinic keratosis before it progresses.
Fluorouracil or imiquimod are considered initial treatments for actinic keratosis.10 Diclofenac is an acceptable alternative. Ingenol Mebutat is the most recently FDA approved the topical drug. As a result, it has not yet been included in the Cancer Guidelines.
Basal cell carcinoma. Fluorouracil (5% concentration) and imiquimod (5% concentration) are treatment options for thin (or superficial) basal cell carcinoma (BCC).1,6 Topic drugs are not as effective as surgery or radiation for BCC. Therefore, they are only used for low-risk BCC if more effective therapies are not possible.
Fluorouracil is a chemotherapy drug. 6 Cancer occurs when cell division goes unchecked. Fluorouracil works by interfering with cell division, causing the cells to die off.
When fluorouracil is applied to the skin, it kills tumor cells on the skin.  It does not reach cells in deeper layers of the skin or in the body. This means fluorouracil works best on abnormal cells on the skin’s surface. This also means that side effects are usually limited to the treatment area. Elsewhere in the body, few side effects occur.
Other names for fluorouracil include 5-fluorouracil or 5-FU. Fluorouracil is also called the brand names Efudex, Fluoroplex, Carac or Tolak.1-4. The branded products vary in concentration from 0.5% (carac) to 5% (Efudex cream).1,3 Some products are used once a day, while others are used twice a day.
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Imiquimod is called in a class of drugs that modify immune response.  This means that Imiquimod activates its own immune system.  However, it is not known exactly how imiquimod treats actinic keratosis or BCC.
Imiquimod is also called Zyclara or Aldara brand names. It comes in concentrations of 2.5% and 3.75% (Zyclara) or 5% (Aldara).1,2 Imiquimod is also used to treat genital and perianal warts.
Diclofenac is a non-steroidal anti-inflammatory drug (NSAID) that can be used in the treatment of actinic keratosis. It is not known exactly how diclofenac gel is treated with actinic keratosis.1
Diclofenac Gel is also called Solaraze under the brand name. Other topical diclofenac products (brand names: Pennsaid, Voltaren) treat arthritis pain.  In pill form, diclofenac is a painkiller.
Ingenol Mebutate causes the abnormal cells in an actinic keratinous lesion to be thieving. 1.2 It also activates your own immune system. This causes immune cells called neutrophils to infiltrate the reading poles. [2) They fight all abnormal cells that survived the original application of the gel.
Ingenol Mebutat is also under the brand name Picato.1 Currently, this drug does not come in generic form.
What are the pros and cons of using topical drugs?
Treating skin lesions with topical medications has several benefits:
- Little to no scarring.
- After the treated area healed, most people are happy with the appearance.
- Treatment option if surgery would be difficult to perform.
Disadvantages of topical drugs include:
Irritation at the treatment site and for several weeks after treatment.
- Not effective for everyone.
- The duration of treatment can be weeks or months.
- The inconvenience of daily use of medication.
- You must avoid direct sunlight during the treatment period.
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Skin Cancer Treatment Options Topical
All topical medications cause skin irritation. Skin reactions in affected areas are worse with some topical drugs compared to others. Your healthcare provider should show you which areas of your skin you are treating and how to use the drugs. Discuss your concerns and preferences with your doctor. Together you can choose the most appropriate treatment for you. Follow your provider’s instructions on the frequency and useful life, and don’t stop using it without talking to your doctor first.