Giant basal cell carcinoma: an old but effective therapy with 5FU

ARTICLE

ejd.2011.1261

Auteur(s) : Severino PERSECHINO severino.persechino@uniroma1.it, Cristiano CAPERCHI, Alessandra ALHADEFF, Gianluca FATUZZO, F. PERSECHINO, Antonella TAMMARO

Sant’Andrea Hospital, via di Grottarossa 1032, 00189 Rome, Italy

We want to emphasize the therapeutic success we have achieved by treating a giant basal cell carcinoma in the breast area with topical 5-fluorouracil, which proves itself to be an old but well-performing therapy.

Basal Cell Carcinoma (BCC) is the most common type of malignant skin tumor in Caucasians [1]. The nodular, superficial spreading, and infiltrating variants are the three most commonly encountered types of BCC. Several alternative therapeutic treatments of basal cell carcinoma are available: surgical therapies (diatermocoagulation, excision, Mohs’ surgery) and non-surgical ones (radiotherapy, cryotherapy, photodynamic therapy, topical 5-fluorouracil, topical imiquimod, intralesional interferon alpha), some of them traditional and others experimental therapies [2-4]. The decision of the most suitable treatment to be used depends on: type of tumor, size of the lesion and the patient's condition.

We report a 69-year-old Caucasian woman, with a large, ulcerous, superficial spreading basal cell carcinoma on the left breast (figure 1A). The patient refused surgical therapy and, considering the size of the lesion, was unsuitable for radiotherapy treatment. For this reason a second-line treatment was chosen: 5 cycles of topical 5-fluorouracil, 20 days each cycle. Complete recovery came after about one year (figure 1B). After each therapeutic cycle there was a period lasting one month during which the patient was not exposed to any treatment.

5-fluorouracil (5-FU) is a topical chemotherapeutic anti-metabolite which destroys clinical foci via interference with DNA and RNA by blocking the methylation reaction of deoxyuridylic acid to thymidylic acid. In this way 5-fluorouracil interferes with the synthesis of DNA and, to a lesser extent, inhibits the formation of RNA. Compared to the cellular cycle, 5-fluorouracil acts on cells only during the mitotic phase and so it has to be considered as cycle-specific chemotherapy [5, 6].

5-fluorouracil treatment in basocellular epitheliomas has to be continued to the ulcerative phase and, in other lesions, to the erosion phase. As a general rule, the treatment lasts 3-4 weeks and, in some cases, a long lasting treatment will be necessary. A BCC lesion, thanks to the effects of 5-fuorouracil, will change as follows: erythema, normally followed by vesicle formation, erosion, ulceration, necrosis and epithelization.

Although 5-fluorouracil is considered safe, local side-effects such as erythema, burning, itching and hyperpigmentation occur; another limit of this anti-metabolite, to be a well performing therapy, is that the treated area of the skin must not be larger than 500 cm² (around 23×23 cm). If larger than 500 cm², it is necessary to divide this area into smaller portions to be individually treated.

We have described this case to underline the therapeutic success obtained with a not-first-line treatment. We believe this method is highly effective and it is a well-tolerated treatment option for superficial basal cell carcinoma. Moreover, it offers a generally good cosmetic outcome; last but not least, it gives high levels of patient satisfaction.

Disclosure

Financial support: none. Conflict of interest: none.

References

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