Intralesional agents in the management of cutaneous malignancy: a review.

Abstract

Intralesional agents have a role in the management of cutaneous malignancies. In this article, the efficacy, side effects, strengths, limitations, costs, and practical considerations regarding the use of intralesional agents to treat basal cell carcinoma, squamous cell carcinoma, selected cutaneous lymphomas, and even metastatic melanoma are reviewed. Intralesional administration of 5-fluorouracil, interferon, interleukin-2, bleomycin with electrochemotherapy, and aminolevulinic acid with photodynamic therapy are discussed as treatment modalities in basal cell carcinoma. Interferon (∼1.5 M IU, 3 times weekly × 3 weeks) is perhaps the most widely used regimen for basal cell carcinoma. With regard to squamous cell carcinoma, treatment with 5-fluorouracil, methotrexate, interferon, and bleomycin are reviewed. Methotrexate (∼0.3-2.0 mL of 12.5 or 25 mg/mL, two injections ∼2 weeks apart) was perhaps the most widely used agent. Interferon (3 M IU × 3 times weekly for ∼8.5 weeks) and rituximab (10-30 mg per lesion, 3 times weekly for 1 week, possibly repeated 4 weeks later) are sometimes used in the management of primary cutaneous B-cell lymphomas, whereas in primary cutaneous CD30(+) lymphoma intralesional methotrexate (0.4-0.5 mL of 50 mg/mL weekly for 2 weeks) has been used. Finally, the roles of BCG vaccine, cidofovir, rose bengal, and bleomycin with electrochemotherapy for the palliation of metastatic melanoma are reviewed. Intralesional management appears most useful when surgical intervention is not a viable option, for cases in which the cosmetic outcome may be superior, or for situations in which the side effects from systemic chemotherapeutic agents are to be minimized.

• Authors: Laurie M Good, Misha D Miller, Whitney A High
• Journal: Journal of the American Academy of Dermatology (J Am Acad Dermatol) Vol. 64 Issue 2 Pg. 413-22 (Feb 2011) ISSN: 1097-6787 [Electronic] United States
• PMID: 20334952 (Publication Type: Journal Article, Review)
• Copyright: Copyright © 2010 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

Chemical References

• Antibodies, Monoclonal, Murine-Derived
• Antineoplastic Agents
• Interferon-alpha
• Interleukin-2
• Bleomycin
• Rituximab
• Aminolevulinic Acid
• Fluorouracil
• Methotrexate

Topics

• Aminolevulinic Acid (administration & dosage, therapeutic use)
• Antibodies, Monoclonal, Murine-Derived (administration & dosage, therapeutic use)
• Antineoplastic Agents (administration & dosage)
• Bleomycin (administration & dosage, therapeutic use)
• Carcinoma, Basal Cell (drug therapy)
• Carcinoma, Squamous Cell (drug therapy)
• Fluorouracil (administration & dosage, therapeutic use)
• Humans
• Injections, Intralesional
• Interferon-alpha (administration & dosage, therapeutic use)
• Interleukin-2 (administration & dosage, therapeutic use)
• Lymphoma, B-Cell (drug therapy)
• Melanoma (drug therapy, pathology)
• Methotrexate (administration & dosage, therapeutic use)
• Neoplasm Metastasis (drug therapy)
• Rituximab
• Skin Neoplasms (drug therapy)