Tumors of the skin. XII. Topical 5-Fluorouracil for epidermal neoplasms.

Abstract

AbstractOur studies have been carried out in over 500 patients with an aggregate of more than 15,000 lesions for observation periods in excess of 5 years. Topical chemotherapy with 5‐FU was shown to result in selective eradication of premalignant and superficial malignant lesions of the skin. Since the action of 5‐FU is selective, it produces minimal or no effects on normal tissues adjacent to tumors. Healing therefore occurs with slight or no apparent scarring. Topical chemotherapy is indicated for solar keratoses and other precancerous lesions as well as for multiple superficial primary skin cancers when standard therapeutic measures are not suitable because large areas of the skin are involved by persistently developing tumors. Topical cancer chemotherapy induces the resolution of premalignant skin lesions and prevents their further development to the malignant stage. Early primary skin cancers and premalignant lesions react to topical antitumor agents before they are otherwise clinically detectable. These tumors can therefore be eradicated before they present significant clinical problems. Early detection and eradication of skin cancers and premalignant skin lesions furthermore result in the reduction of the subsequent incidence of clinically significant tumors. Local chemotherapy therefore appears to have prophylactic value. Local administration of 5‐FU results in high concentrations of the antitumor agent at the tumor site, although the total amount administered and the rate of absorption are relatively low. General toxicity such as bone marrow depression and other systemic side‐effects are therefore not encountered with local cancer chemotherapy. Superficially located neoplasms are suitable model systems for the study of tumor biology. Local chemotherapy indicates that differential and selective chemical effects can be produced in neoplastic cells and their normal counterparts. Studies on local chemotherapy demonstrate that the selective eradication of malignant disease in many by chemical means is feasible.