Intralesional 5-Fluorouracil in the Treatment of Squamous Cell Carcinoma in an Elderly Patient

TL;DR

An elderly patient with skin cancer was successfully treated with a non-surgical injection of 5-fluorouracil, offering an alternative for those who can't undergo surgery.

Contribution

Demonstrates the effectiveness of intralesional 5-fluorouracil for treating cutaneous squamous cell carcinoma in elderly, high-risk patients.

Findings

Intralesional 5-fluorouracil eliminated a large, ulcerated SCC tumor in a 98-year-old patient.

No tumor recurrence was observed at three months post-treatment.

Treatment was feasible for patients with comorbidities that preclude surgery or radiation.

Abstract

Squamous cell carcinoma (SCC) is the second leading form of skin cancer. In the elderly population, surgery may carry more risk and significant morbidity in comparison to less invasive forms of treatment. This case report describes the successful use of intralesional 5-fluorouracil (IL5-FU) to treat cutaneous squamous cell carcinoma (cSCC). A 98-year-old white woman presented in early May 2017 with a 3.5-cm rapidly growing crusted nodule on her left proximal-lateral arm. She had a past medical history of chronic obstructive pulmonary disease, atrial fibrillation, and heart failure. The patient also had a frail body habitus and weighed 80 pounds. Physical examination revealed a large, ulcerated, crateriform mass on the left proximal-lateral arm. A shave biopsy was performed, which revealed a well-differentiated SCC, composed of nodular masses of neoplastic squamous cells with atypical nuclei, keratin pearl formation, and scattered mitotic figures with surrounding fibrosis and inflammation. The patient was wheelchair-bound and oxygen-dependent and, thus, not considered a good surgical or radiation candidate. Treatment was decided with 5-fluorouracil. At a four-week follow-up appointment, there was no visible or palpable evidence of the tumor. There was no sign of recurrence at three months, indicating treatment success. The patient later died due to cardiac arrest in September 2017. The elderly population with cSCC can benefit from intervention and treatment with IL5-FU when surgery is not an option due to patient comorbidities. IL5-FU can potentially be used in areas where access to a dermatologist, surgeon, or surgical services is limited.

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