Topical and Intralesional Treatment of Nonmelanoma Skin Cancer: Efficacy and Cost Comparisons

BACKGROUND: Topical chemotherapy, topical immunomodulators, or intralesional chemotherapy may be used to treat nonmelanoma skin cancer (NMSC). OBJECTIVES: To review the cost and efficacy of topical and intralesional therapies for NMSC. METHODS: 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. RESULTS: 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). CONCLUSION: 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.