0521779407-15 CUNY1086/Karliner 0 521 77940 7 June 7, 2007 18:43
Nonmelanoma Skin Cancers: SCC 1065■RADIATION THERAPY
➣Best for patients >55 with smaller lesions or those unwilling or
unable to have surgery
➣Mainly if perineural invasion
➣May be an adjunct to excision of large and/or aggressive histo-
logic types
➣May be used as palliation of nonresectable tumors
➣Disadvantages: scars worsen with time, risk of secondary can-
cer after many years, may lead to permanent alopecia and bone
necrosis on scalp or forehead. Not for previously x-rayed tumors
or most recurrent lesions.
■TOPICAL 5 Fluorouracil (5-FU)
➣For very superficial, noninvasive, and Bowen’s disease
➣Disadvantage: may eliminate the superficial component with
persistence of deeper subclinical foci
■LASER
➣Blind destructive procedure. Similar results with Cryo, C&D and
x-ray.
➣May be more costly
■Photodynamic Therapy
➣Application of photosensitizing agent followed by light exposure
➣Another form of destruction
➣Requires at least 2 visits per treatment
■INVESTIGATIONAL
➣Intralesional 5-FU
➣Systemic retinoids
➣Interferonfollow-up
■Self-examination with regular follow-up by a physician with exper-
tise in skin cancer
■Life-long follow-up to detect new primary skin cancers and recur-
rence of previously treated lesions. Examination to include regional
lymph nodes.
■Most follow up q6–12 months unless “high-risk patient” w/ multiple
CAs, severe photodamage, immunosuppression, presence of multi-
ple precancerous lesions such as HPV or AKs.
■Periodic general medical evaluation to detect other cancers such as
cancer of the respiratory organs, oral cavity, small intestine, non-
Hodgkin’s lymphoma and leukemia
■PREVENTION