Successful treatment with topical 0.5% fluorouracil and imiquimod 5% cream in the treatment of a patient with actinic keratosis and squamous cell carcinoma

Abstract

Actinic keratosis (AK) lesions are dysplastic epidermal lesions commonly identified in fair-skinned patients who have had excessive sun exposure. Compelling evidence of their premalignant status, underlines the need for close monitoring and early treatment of these lesions. Treatment of AK lesions with topical 0.5% fluorouracil is effective and may be most appropriate for patients with widespread actinic damage. A 60-year-old white male with Fitzpatrick skin type II presented with a history of squamous cell carcinoma and multiple AK lesions and reported a childhood history of numerous burns and blistering eruptions. The patient is bald, and as a result, frequently develops AK lesions and squamous cell carcinoma on the scalp. Previous treatment included cryosurgery on numerous occasions with limited success and frequent recurrences. Clinical examination revealed over 30 hypertrophic AK lesions on the scalp and a large squamous cell carcinoma measuring 1.2 cm by 1.2 cm. Due to the diffuse nature of the AK and squamous cell carcinoma, topical treatment with imiquimod 5% cream, once daily at bedtime was implemented. Following 10 days of therapy, no response was observed. At that time, topical 0.5% fluorouracil cream applied once daily was added to the treatment regimen. Concomitant treatment with both topical 0.5% fluorouracil cream (applied at bedtime) and imiquimod 5% cream (applied in the morning) continued for 2 weeks during which the patient developed a painful exuberant reaction that resulted in thickcrusted lesions and edema. Following compression of the area and application of petroleum jelly, the patient healed completely without sequelae and experienced no recurrences of lesions 1 year following treatment.