College of Medicine, University of South Florida, Tampa, Florida.
Dermatol Surg. 2013 Sep;39(9):1306-16. doi: 10.1111/dsu.12300. Epub 2013 Aug 5.
Topical chemotherapy, topical immunomodulators, or intralesional chemotherapy may be used to treat nonmelanoma skin cancer (NMSC).
To review the cost and efficacy of topical and intralesional therapies for NMSC.
Literature search assessing the efficacy of NMSC treatment with topical imiquimod, topical 5-fluorouracil (5FU) intralesional 5FU, methotrexate, bleomycin, and interferon (IFN). Single-lesion case reports were excluded. Aggregate cure rates and the estimated cost of treatment (including excision and repair of recurrent lesions) for a sample 1-cm lesion on an extremity were calculated.
Cure rates ranged from 65% to 100% for topical imiquimod and 61% to 92% for 5FU. For intralesional agents, cure rates varied considerably according to medication used and NMSC subtype treated. Keratoacanthomas had high cure rates with intralesional agents: 98% for 5FU, 91% for methotrexate, 100% for bleomycin, 100% for IFN alpha (α)-2, 83% for IFN α-2a, and 100% for IFN α-2b. Estimated costs (excluding medication cost) ranged from $205 (intralesional methotrexate for keratoacanthoma) to $1,174 (IFN α-2a for superficial basal cell carcinoma).
Nonsurgical management of NMSC remains a viable and relatively cost effective treatment option in select cases. Providers should consider the relative efficacy and cost of each medication when using nonsurgical modalities.
局部化疗、局部免疫调节剂或病灶内化疗可用于治疗非黑素瘤皮肤癌（NMSC）。
综述 NMSC 局部和病灶内治疗的成本和疗效。
检索评估咪喹莫特、病灶内 5-氟尿嘧啶（5FU）、甲氨蝶呤、博来霉素和干扰素（IFN）治疗 NMSC 的疗效的文献。排除单病灶病例报告。计算了肢体 1cm 病变样本的总体治愈率和治疗费用（包括切除和修复复发性病变）的估计值。
局部咪喹莫特的治愈率为 65%至 100%，5FU 为 61%至 92%。对于病灶内药物，治愈率因所用药物和治疗的 NMSC 亚型而异。角化棘皮瘤病灶内药物治愈率高：5FU 为 98%，甲氨蝶呤为 91%，博来霉素为 100%，IFNα-2 为 100%，IFNα-2a 为 83%，IFNα-2b 为 100%。（不包括药物费用）估计费用范围为 205 美元（角化棘皮瘤病灶内甲氨蝶呤）至 1174 美元（浅表基底细胞癌 IFNα-2a）。
在某些情况下，NMSC 的非手术治疗仍然是一种可行且相对经济有效的治疗选择。在使用非手术方法时，医生应考虑每种药物的相对疗效和成本。
