Abstract
Objectives: Basal Cell Carcinoma (BCC) is the most common skin cancer generally treated by a variety of surgical and non-surgical destructive therapies. A Concentrate of Proteolytic Enzymes Enriched in Bromelain (CPEEB) derived from the stems of pineapples is approved for use for debriding deep burns. Prior studies suggest that bromelain also has anti-tumor effects. We describe our preliminary off-label treatment experience using topical CPEEB for the destruction of six BCCs in three patients. Methods: CPEEB was self-applied by three patients on six different Morphea, nodular, and superficially invasive BCCs. The CPEEB was applied as a thin layer prior to bedtime and left for a period of 9-12 hours. The wound was then covered with a petrolatum-based ointment for the next 24 hours. Application of the CPEEB was repeated up to 5 times over the course of 10 days, during which the patients were monitored daily and reevaluated by a board-certified plastic surgeon. If necessary, the CPEEB was reapplied up to five additional times over the next 10-day period. If necessary, any remaining lesion was surgically excised (MOHS surgery). The patients were then followed for up to 1 year. Results: Six BCCs located on the face, neck, and extremities were self-treated by three patients with 2-6 CPEEB applications. All of the BCCs were completely removed after the CPEEB application. CPEEB application was associated with local irritation and mild itching pain which resolved untreated within hours. In one patient, two of the lesion’s sites were surgically excised after 6 months with no tumor cells noted on histopathology. None of the BCCs recurred over the next 1 year. Conclusion: Our preliminary findings are a proof-of-concept that a concentrate of proteolytic enzymes enriched in bromelain may be a safe and effective destructive treatment for basal cell carcinomas. Future studies on larger groups of BCC patients are necessary in order to elucidate the potential use of CPEEB for this indication.
Highlights
Skin cancer is the most common cancer in humans, mostly caused by unrepaired solar-induced DNA damage
Our preliminary findings are a proof-of-concept that a concentrate of proteolytic enzymes enriched in bromelain may be a safe and effective destructive treatment for basal cell carcinomas
Future studies on larger groups of Basal Cell Carcinomas (BCC) patients are necessary in order to elucidate the potential use of Concentrate of Proteolytic Enzymes Enriched in Bromelain (CPEEB) for this indication
Summary
Skin cancer is the most common cancer in humans, mostly caused by unrepaired solar-induced DNA damage. About 8 of 10 skin cancers are Basal Cell Carcinomas (BCC), with over ~4.3 million cases annually in the United States alone [1 - 4]. Treatment of BCC is mainly based on tumor destruction by a variety of surgical (e.g., excisional biopsy followed by MOHS micrographic surgery) and non-surgical (e.g., cryosurgery, electric or laser desiccation, 5-fluorouracil cream, imiquimod) methods. Many of the current therapies require specialized personnel or facilities (e.g., MOHS surgery) or are prolonged (5-flurouracil), often involving adverse events. Most topical therapies result in considerable local irritation and high recurrence rates [5].
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