Información del artículo
Abstract
Actinic keratosis is currently considered not to be a precursor of squamous cell carcinoma but, rather, an initial stage of the disease. Furthermore, the incidence of both squamous cell carcinoma and basal cell carcinoma continues to increase. Topical drugs are now becoming widely used in the therapeutic management of nonmelanoma skin cancer and its precursor lesions. Here, we review the various topical drugs that are currently available and discuss their advantages and drawbacks. Therapeutic options include retinoids, 5-fluoracil, diclofenac, imiquimod, and photodynamic therapy.
Key words:
actinic keratosis
nonmelanoma skin cancer
topical treatment
Resumen
Actualmente se considera que la queratosis actínica no es un precursor del carcinoma de células escamosas, sino un estadio inicial del mismo, y la incidencia tanto del carcinoma escamocelular como del basocelular está en continuo aumento. Dentro del manejo terapéutico del cáncer cutáneo no melanoma, así como de las lesiones precursoras, se está imponiendo el uso de agentes farmacológicos tópicos. En el siguiente artículo se revisan las diversas alternativas farmacológicas tópicas de las que se dispone actualmente y se discuten sus ventajas y limitaciones. Entre estas alternativas se encuentran los retinoides, el 5-fluoracilo, el diclofenaco, el imiquimod y la terapia fotodinámica.
Palabras clave:
queratosis actínica
cáncer cutáneo no melanoma
tratamiento tópico
El Texto completo está disponible en PDF
References
[1.]
J. Jorizzo, P. Carney, W. Ko.
Treatment options in the management of actinic keratosis.
Cutis, 74 (2004), pp. 9-17
[2.]
Y.G.L. Graaf, S. Euvrard, J.N.B. Bavinck.
Systemic and topical retinoids in the management of skin cancer in organ transplant recipients.
Dermatol Surg, 30 (2004), pp. 656-661
[3.]
A. Campanelli, L. Naldi.
A retrospective study of the effect of long-term topical application of retinaldehyde (0.05%) on the development of actinic keratosis.
Dermatology, 205 (2002), pp. 146-152
[4.]
K. Peris, M.C. Fargnoli, S. Chimenti.
Preliminary observations on the use of topical tazarotene to treat basal-cell carcinoma.
N Engl J Med, 341 (1999), pp. 1767-1768
[5.]
H. Xu, S. Cheepala, E. McCauley, K. Coombes, L. Xiao, S.M. Fischer, et al.
Chemoprevention of Skin Carcinogenesis by Phenylretinamides: Retinoid Receptor-Independent Tumor Suppression.
Clinical Cancer Research, 12 (2006), pp. 969-979
[6.]
B. Lober, N. Fenske.
Optimum treatment strategies for actinic keratosis (intraepidermal squamous cell carcinoma).
Am J Clin Dermatol, 5 (2004), pp. 395-401
[7.]
S. McGillis, H. Fein.
Topical treatment strategies for nonmelanoma skin cancer precursor lesions.
Semin Cutan Med Surg, 23 (2004), pp. 174-183
[8.]
W. Tutrone, R. Saini, S. Caglar, J. Weinberg, J. Crespo.
Topical therapy for actinic keratoses, I: 5-fluoracil and imiquimod.
Cutis, 71 (2003), pp. 365-370
[9.]
S. Silapunt, L. Goldberg, M. Alam.
Topical and light-based treatments for actinic keratoses.
Semin Cutan Med Surg, 22 (2003), pp. 162-170
[10.]
G. Russo.
Actinic keratoses, basal cell carcinoma and squamous cell carcinoma: uncommon treatments.
Clin Dermatol, 23 (2005), pp. 581-586
[11.]
K. Gebauer, P. Brown, G. Varigos.
Topical diclofenac in hyaluronan gel for the treatment of solar keratoses.
Austr J Dermatol, 44 (2003), pp. 40-43
[12.]
J. Rosso.
New and emerging topical approaches for actinic keratoses.
Cutis, 72 (2003), pp. 273-279
[13.]
P. Lang.
Management of actinic keratoses.
Comp Ther, 29 (2003), pp. 108-114
[14.]
J. Rosso.
Imiquimod 5% cream in the treatment of cutaneous epithelial malignancy: optimal use and duration of therapy.
Cosmetic Dermatol, 18 (2005), pp. 661-665
[15.]
J. Jorizzo.
Current and novel treatment options for actinic keratosis.
J Cutan Med Surg, 8 (2005), pp. 13-21
[16.]
R. Marks, K. Gebauer, S. Shumack, M. Amies, J. Bryden, T.L. Fox, Australasian multicentre trial group, et al.
Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multicenter 6-week dose-response trial.
J Am Acad Dermatol, 44 (2001), pp. 807-813
[17.]
J.K. Geisse, P. Rich, A. Pandya, K. Gross, K. Andres, A. Ginkel, et al.
Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: a double-blind, randomized, vehicle-controlled study.
J Am Acad Dermatol, 47 (2002), pp. 390-398
[18.]
J. Geisse, I. Caro, J. Lindholm, L. Golitz, P. Stampone, M. Owens.
Imiquimod 5% cream for the treatment of superficial basal carcinoma: results from two phase III, randomized, vehicle-controlled studies.
J Am Acad Dermatol, 50 (2004), pp. 722-733
[19.]
M. Falagas, A. Angelousi, G. Peppas.
Imiquimod for the treatment of actinic keratosis: a meta-analysis of randomized controlled trials.
J Am Acad Dermatol, 55 (2006), pp. 537-538
[20.]
A. Gupta, V. Davey, H. Mphail.
Evaluation of the effectiveness of imiquimod and 5-fluorouracil for the treatment of actinic keratosis: critical review and metaanalysis of efficacy studies.
J Cutan Med Surg, 9 (2005), pp. 209-214
[21.]
C. Quirk, K. Gebauer, M. Owens, P. Stampone.
Two-year interim results from a 5-year study evaluating clinical recurrence of superficial basal cell carcinoma after treatment with imiquimod 5% cream daily for 6 weeks.
Australas J Dermatol, 47 (2006), pp. 258-265
[22.]
D. Vidal, X. Matias-Guiu, A. Alomar.
Fifty-five basal cell carcinomas treated with topical imiquimod: outcome at 5-year follow-up.
Arch Dermatol, 143 (2007), pp. 266-268
[23.]
S. Shumack, J. Robison, S. Kossard, L. Golitz, H. Greenway, A. Schroeter, et al.
Efficacy of topical 5% imiquimod for the treatment of nodular basal cell carcinoma.
Arch Dermatol, 138 (2002), pp. 1165-1171
[24.]
J. Eklind, U. Tartler, J. Maschke, P. Lidbrink, U.R. Hengge.
Imiquimod to treat different cancers of the epidermis.
Dermatol Surg, 29 (2003), pp. 890-896
[25.]
G. Micali, F. Lacarrubba, M.R. Nasca, R. De Pasquale.
The use of imiquimod 5% cream for the treatment of basal cell carcinoma as observed in Gorlin's syndrome.
Clin Exp Dermatol, 28 (2003), pp. 19-23
[26.]
D. Roseeuw.
The treatment of basal skin carcinomas in two sisters with xeroderma pigmentosum.
Clin Exp Dermatol, 28 (2003), pp. 30-32
[27.]
C. Ulrich, J. Busch, T. Meyer, I. Nindl, T. Schmook, W. Sterry, et al.
Successful treatment of multiple actinic keratoses in organ transplant patients with topical 5% imiquimod: a report of six cases.
Br J Dermatol, 155 (2006), pp. 451-454
[28.]
J. Rosso.
The use of topical imiquimod for the treatment of actinic keratosis: a status report.
Cutis, 76 (2005), pp. 241-248
[29.]
L. Braathen, R.M. Szeimies, N. Basset-Seguin, R. Bissonnette, P. Foley, D. Pariser, et al.
Guidelines on the use of photodynamic therapy for nonmelanoma skin cancer: an international consensus.
J Am Acad Dermatol, 56 (2007), pp. 125-143
[30.]
D.M. Pariser, N.J. Lowe, D.M. Stewart, M.T. Jarrat, A.V. Lucky, R.J. Pariser, et al.
Photodynamic therapy with topical methyl aminolevulinate for actinic keratosis: results of a prospective randomized multicenter trial.
J Am Acad Dermatol, 48 (2003), pp. 227-232
[31.]
C. Morton, M. Horn, J. Lehman, B. Tack, C. Bedane, M. Tijoe, et al.
A 24-month update of a placebo controlled European study comparing MAL-PDT with cryotherapy and 5-fluoracil in patients with Bowen's disease.
J Eur Acad Dermatol Venereol, 19 (2005), pp. 237-238
[32.]
W.D. Tope, A. Menter, R.A. El-Azhary, N.J. Lowe, M. Jarrat, D.M. Pariser, et al.
Comparison of topical methyl aminolevulinate photodynamic therapy versus placebo photodynamic therapy in nodular BCC.
J Eur Acad Dermatol Venereol, 18 (2004), pp. 413-414
[33.]
C.M. Perrett, J.M. McGregor, P. Warwick, P. Karran, I.M. Leigh, C.M. Proby, et al.
Treatment of post-transplant premalignant skin disease: a randomized intrapatient comparative study of 5-fluorouracil cream and topical photodynamic therapy.
Br J Dermatol, 156 (2007), pp. 320-328
Copyright © 2007. Academia Española de Dermatología y Venereología and Elsevier España, S.L.
