News

Intralesional interferon excels for challenging basal cell carcinomas


 

EXPERT ANALYSIS FROM SDEF HAWAII DERMATOLOGY SEMINAR

References

WAIKOLOA, HAWAII – Intralesional injection of interferon alfa-2b is an excellent option for the treatment of large problematic basal cell carcinomas in patients who aren’t interested in the higher-morbidity options, Dr. David L. Swanson said at the Hawaii Dermatology Seminar provided by Global Academy for Medical Education/Skin Disease Education Foundation.

“This is a really effective way to treat basal cell carcinomas. These things just melt away before your eyes. It’s really quite amazing,” observed Dr. Swanson of Mayo Clinic Scottsdale (Ariz.).

Dr. David L. Swanson

Dr. David L. Swanson

He finds this therapy particularly useful in frail elderly patients who have a large BCC on the head or neck. A good example would be an 89-year-old with multiple comorbid conditions who has a 2-cm BCC on the tip of the nose and doesn’t want anything done about it. The patient declines the options of Mohs micrographic surgery or radiotherapy.

“This is the patient who just wants to be left alone. That’s fine if they’re going to be dead within a year, but if they’re going to be around for several years, that basal cell carcinoma could become a major issue for them,” the dermatologist continued.

He and his colleagues at the Mayo Clinic follow a treatment regimen similar to one laid out by Turkish investigators more than a decade ago in one of the few long-term outcome studies of intralesional interferon for treatment of BCCs.

Although interferon alfa-2b is approved for the intralesional treatment of genital warts and subcutaneously for Kaposi’s sarcoma and malignant melanoma, among other conditions, it’s off-label therapy for BCCs. The treatment entails thrice-weekly intralesional injections for 3 weeks. The dosing is 1.5 million units per injection for BCCs smaller than 2 cm and 3 million units per injection for BCCs that are 2 cm or larger. The injections are given without anesthesia, but premedication with 500-1,000 mg of acetaminophen is advisable to minimize aches and fever.

Interferon alfa-2b (Intron A) comes in a vial containing 10 million units with 1 mL of diluent. It’s important to reconstitute it carefully, similar to onabotulinumtoxin. Don’t shake it, Dr. Swanson advised.

The Turkish report included 20 patients with histopathologically proven BCCs on the head or neck. At clinical and dermatopathologic follow-up 8 weeks after the last interferon injection, 11 BCCs showed complete clinical and histopathologic cure, six showed partial remission, two showed no response, and one actually increased in size during treatment.

The 11 patients with an initial complete cure were followed for 7 years. During that period, only one of the 11 skin cancers recurred, at the fifth year (Clin Drug Investig. 2005;25[10]:661-7).

Dr. Swanson reported having no financial conflicts regarding his presentation. SDEF and this news organization are owned by the same parent company.

bjancin@frontlinemedcom.com

Recommended Reading

VIDEO: Genetic tests, clinical data sharpen pigmented lesion diagnosis
MDedge Dermatology
Ibrutinib bodes well for relapsed mantle-cell lymphoma
MDedge Dermatology
RECIST underestimates benefit of pembrolizumab in subset of melanoma patients
MDedge Dermatology
Children who have stem cell transplants need skin exams, sun protection
MDedge Dermatology
Itraconazole targets basal cell carcinoma
MDedge Dermatology
Poor Sun Protection Practices in Hispanic Patients Increases Risk for Skin Cancer
MDedge Dermatology
Nicotinamide Prevents Actinic Keratoses, Basal Cell Carcinomas, and Squamous Cell Carcinomas
MDedge Dermatology
Low vitamin D linked with worse outcome in melanoma
MDedge Dermatology
Does sharing genetic risk change behavior?
MDedge Dermatology
Tools for Diagnosing Skin Cancer Earlier: Report From the AAD Meeting
MDedge Dermatology