Topical Chemotherapy: A Non-Invasive Skin Cancer Treatment

People diagnosed with skin cancer often opt for surgery due to its fast results and high cure rate. However, surgery is generally more suited for moderate to severe cases of skin cancer, where tumor cells grow rapidly and have a high potential for spreading. For slower-growing tumors and early-stage skin cancers, topical chemotherapy offers a highly effective alternative, boasting several compelling advantages.

IN THIS ARTICLE

1. Understanding Topical Chemotherapy
2. Who Benefits Most from Topical Chemotherapy?
3. How Effective Is Topical Chemotherapy?
4. How to Use Topical Chemotherapy
5. Potential Side Effects and Risks
6. Topical Chemotherapy Changes the Game in Skin Cancer Treatment
7. Non-Invasive Skin Cancer Treatment FAQs 

Topical chemotherapy involves the application of a cream, gel, ointment, or solution directly onto the skin to kill cancer cells without affecting deeper tissues. This method is primarily used to treat precancerous conditions and early-stage or superficial skin cancers. Dermatologists often describe this treatment as "local" because it targets only the tumor cells that are confined to the epidermis. 

How Does Topical Chemotherapy Work?

Topical chemotherapy drugs contain chemicals that fight cancer cells through various mechanisms. Some stimulate an immune response to combat tumor cells, while others inhibit their aggressive growth and induce cell death. (Tan et al., 2023)

Imiquimod cream, for example, belongs to a class of drugs known as immune response modifiers. Once applied to the skin, it increases the activity of your body's natural defense system to fight against inflammation that promotes skin cancer. 

Skin Cancer Types That Can Be Treated Topically

Not all types of skin cancers are treatable at home. Dermatologists often prescribe topical treatments for curing two main types of skin cancers:

• Basal cell carcinoma (BCC) affects 5.2 million Americans, making it the most prevalent type of skin cancer in the United States. If the current prediction holds up, experts estimate an additional 3.6 million cases yearly. (Tan et al., 2023) Fortunately, topical modalities can help manage the increasing figures. 
• Actinic keratosis (AK) — also known as solar keratosis — is another skin condition where topical treatments for skin cancer showcase a high success rate. AK is a precancerous lesion that appears as a patch of scaly, rough skin. Its primary cause is chronic exposure to ultraviolet rays and can affect the ears, scalp, face, and forearms. By incidence, it's common in people over 40 years old. If AK is left untreated, it progresses into a form of skin cancer called squamous cell carcinoma (SCC). 

In general, topical chemotherapy has a higher chance of effectiveness on slow-developing and low-risk types of skin cancer. 

FDA-Approved Medications for Topical Chemotherapy

The most commonly prescribed FDA drugs for topical treatment of skin cancer are imiquimod, fluorouracil, tirbanibulin, and diclofenac. (Tan et al., 2023)

• Imiquimod 2.5%, 3.75%, and 5% creams are used to manage hyperkeratosis or the patches of thickened skin on the scalp or face. It's a precursor to AK. Using this medication prevents hyperkeratosis from advancing to AK. 
• 5-fluorouracil 5% cream belongs to a class of drugs called antimetabolites. It works by stopping the growth of tumor cells and promoting their death. It's FDA-cleared for surface BCC and usually applied to the affected area twice daily for 3-6 weeks.
• Tirbanibulin 1% ointment is another FDA-regulated topical drug to treat scalp and facial AK. It's categorized as a microtubule inhibitor, stopping the cancer cells from dividing or migrating to other areas. 
• Diclofenac 3% which comes in the form of gel belongs to a class of non-steroidal anti-inflammatory drugs (NSAIDs). It helps treat AK by reducing inflammation and cell growth. 

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Topical Chemotherapy vs. Traditional Surgery

Topical skin cancer therapy can be just as effective as Mohs micrographic surgery, which is considered the gold standard in operative skin cancer treatment. However, opting for a nonsurgical approach boasts its own share of upsides that appeal to some people. It includes the following benefits:

1. It's non-invasive: Although highly effective, Mohs surgery still requires minor incision and local anesthesia. Topical treatments don't. 

2. It minimizes scarring: Surgery often leaves you with a scar that's either permanent or requires long-term post-care.  Opting for creams with anti-cancer benefits can preserve the appearance of your skin. 

3. It's effective: Topical chemotherapy works best for surface BCC and AK. Unless your cancer is aggressive and deep, this nonintrusive approach is better than going under the knife. 

4. It's convenient: Skin cancer treatment surgery often requires you to take a few days off work from pre- to post-operative care, whereas topical chemotherapy can be done at home without major preparation.

5. Minimal downtime: With a topical approach, you can continue your daily activities while undergoing treatment. Surgery requires recovery time, which can disrupt your daily routines. 

Unlike surgery that eliminates cancer cells in a single operation, topical therapy can take several weeks to months to work. On the flip side, you can continue your daily activities while undergoing home treatment, unlike surgery that requires recovery time, limiting the activities you can do for a few weeks.

A study revealed the impressive success rate of topical chemotherapy, comparable with some surgical treatments. Here are the summary findings: (Tan et al., 2023)

1. Imiquimod 5% cream cleared nodular BCC — a type of BCC where lesions appear on the head and face — 70% of the time. Skin cancer had a low probability of recurring within 5 years following the treatment. 
2. Topical 5-fluorouracil 5% cream was more effective than destructive treatments like cryotherapy for treating superficial BCC and early-stage squamous cell carcinoma. 
3. Tirbanibulin 1% ointment also completely got rid of AK in 49% of patients while 72% confirmed partial recovery from it. The appearance of lesions was reduced by 87.5%. 

Overall, it has been proven that using a chemotherapy cream is an encouraging initial intervention for benign and early forms of skin cancer. 

Who Benefits Most from Topical Chemotherapy?

Despite its many notable upsides, this non-invasive skin cancer treatment isn't for everyone. It may be an option for: 

• Patients with superficial cases of skin cancer: BCC, for instance, is a slow-growing cancer. A topical means is likelier to be effective as an early intervention in destroying tumor cells.

• Patients with lesions: Anti-cancer creams, ointments, and gels can treat precancerous lesions in those with AK.

• People who prefer a non-invasive treatment: Some patients may choose a nonsurgical approach to avoid scarring, anesthesia, or procedures that require incision or excision.

• Patients who can't undergo surgery: Some people may also avoid a medical operation because it can complicate an existing condition. For example, those diagnosed with diabetes mellitus, congestive heart failure, or malnutrition may slow down the healing process post-operation, which can cause a problem. (Cheng, 2012) (This resource was updated in 2024.) 

Minor topical chemotherapy side effects to watch out for include: 

• Redness
• Discoloration
• Pain
• Itching
• Soreness
• Discoloration
• Burning 
• Crusting

Meanwhile, serious side effects can include: 

• Bloody diarrhea 
• Intense stomach pain
• Chills
• Fever
• Worse red skin rash 

Slight side effects are well tolerated. You can manage them by switching to gentle skincare products to moisturize the treated area. Additionally, avoid direct sunlight and use sunscreen with at least SPF 30 when going out. 

If you’re concerned about the risks or are likely to experience worrying adverse reactions, talk to your doctor about other cancer treatment services that may better suit your health situation.

Traditionally, surgery has been the go-to option for treating skin cancer, often viewed as the most direct and quick method. However, for those seeking a less invasive alternative, topical chemotherapy presents a viable option. This approach is non-invasive, convenient, and effective, particularly for treating early-stage basal cell carcinoma and actinic keratosis without the need for surgical intervention.

Considering topical chemotherapy as a treatment option for your skin cancer? Schedule a consultation with Altitude Dermatology to explore your options today.