RHODES, GREECE Combining topical immunomodulatory therapy or topical chemotherapy with cryosurgery provides an excellent alternative to excisional treatment for many skin malignancies, Dr. Paola Pasquali said at the 15th Congress of the European Academy of Dermatology and Venereology.
Cryosurgery itself represents an excellent option for many skin malignancies, including most basal cell carcinomas. Exceptions include morpheaform, metatypical, and neurotropic basal cell carcinomas, for which Mohs surgery is preferable. Cryosurgery is also beneficial for well-differentiated squamous cell carcinomas and lentigo maligna, she said.
The use of the immune response modifier imiquimod before any surgical intervention can improve local immune response and reduce treatment areas. Cryosurgery can then be used to treat areas that failed to respond, said Dr. Pasquali, a dermatologist in private practice in Caracas, Venezuela.
This approach is particularly useful in patients with severe sun damage with multiple actinic keratoses or superficial basal cell carcinomas, she said, noting that she has her patients use imiquimod 5 days a week for 6 weeks, followed by cryotherapy for remaining lesions.
This reduces the need for surgical treatment and provides a better cosmetic outcome, she said.
For nodular basal cell carcinomas, biopsy and curettage is performed, and the lesion is allowed to heal before imiquimod treatment is initiated and cryosurgery is used to treat remaining lesions.
Topical chemotherapy with the antimetabolite 5-fluorouracil can also be used along with cryosurgery in some patients, such as those with actinic keratoses or Bowen's disease.
As with imiquimod, the topical treatment is used to reduce the number and size of lesions and the remaining lesions are treated with cryosurgery.
These combinations also are useful for palliation in patients with large tumors, Dr. Pasquali noted.
This female patient had a hypertrophic actinic keratosis that was associated with a squamous cell carcinoma and severe actinic damage.
Improvement was evident after cryosurgery of the nodular lesion and treatment with imiquimod on the rest of the patient's damaged skin. Photos Courtesy Dr. Paola Pasquali