Many people dealing with precancer have precancerous lesions, such as actinic keratoses, on the surface of their skin. If it is only on the surface of their skin (i.e. has not spread to surrounding tissues, bones, or organs), this can provide a silver lining to those patients, as there are several topical treatments available that can help to eliminate the precancer before it develops into skin cancer that can lead to more extensive treatments.
There are several topical treatments available to battle precancer and eliminate it before skin cancer develops. These treatments include creams that stimulate the immune system to respond against the precancerous cells, chemotherapy agents that directly target the precancerous cells, and anti-inflammatory agents that can eliminate some actinic keratoses in as little as three-months time.1
Topical Creams that Stimulate an Immune Response
There are several topical immunomodulators (i.e. creams that stimulate an immune response to attack the precancer cells) that have been approved by the FDA to fight precancer and to keep it from developing into cancer.
One of the most widely used is Imiquimod (often known as Aldara on the market). When this topical cream is applied to the skin, it prompts your immune system to begin attacking the precancerous cells, often eliminating them before they can turn into skin cancer.
Topical creams such as Imiquimod will often be used to treat multiple actinic keratoses, since it’s easier for a patient to apply a cream to such areas than it is for a doctor to surgically remove each precancerous lesion by conventional means, cryotherapy, or laser.
In addition, topical creams will not only treat visible skin lesions, but will also work to eliminate any lesions that are microscopic and hidden from the naked eye.2 This will help to increase the chances of eradicating the precancer before it develops into skin cancer.
Imiquimod cream is usually applied to the skin 2-3 times per week for a period of 6-12 weeks. This will vary based upon the response of the patient to the cream, including any irritation the patient may experience from the application of the cream. Irritation is the only real disadvantage to using these creams, as they need to be applied for several weeks in order to be effective, which can cause crusting, swelling, and redness of the areas in which the cream is applied.2
Topical Treatments with Chemotherapy Agents
There are topical treatments available that utilize chemotherapy agents. This means that the creams directly target the precancerous cells, such as actinic keratoses. These creams are sometimes referred to as “topical chemotherapy.”
One such cream is 5-fluorouracil (commonly known in the market as either Efudex or Carac).1 This cream contains 5-FU, which is a type of anti-cancer drug that directly attacks the precancerous cells by inhibiting the formation of DNA and RNA, which allows cells to divide and grow.3 Since precancerous cells will absorb more 5-fluorouracil than healthy cells, the precancerous cells will be the most affected by the 5-fluorouracil.
Most patients will use this type of cream every day for 4-6 weeks. However, some patients will be instructed to not use this cream every day, but instead, will be instructed to use it just a few days a week over a period that is longer than the usual 4-6 week period. This method of prescription is known as a “pulsed fashion.”2
Topical Creams with Anti-Inflammatory Agents
Another type of topical cream uses anti-inflammatory agents to eliminate some actinic keratoses over a period of 3 months. One commonly prescribed medication of this type is Diclofenac (often known on the market as Solaraze). This type of topical cream is applied to the skin in order to cause all precancerous lesions to turn red and inflamed.4
After a brief period of time, the precancerous lesions often disappear, allowing for the elimination of the precancer before it develops into skin cancer.
The Advantages and Disadvantages of Topical Creams
Topical creams are normally preferred to more invasive procedures such as operating with medical instruments, lasers, and freezing because the chances of complications from applying topical creams are fewer and less severe. With many precancerous skin lesions, topical creams can be quite effective in eliminating them and preventing them from developing into skin cancer.
However, there are some disadvantages to topical creams. One disadvantage is that these creams must usually be applied every day continuously for a matter of weeks in order to see optimal improvement. These topical creams will not work instantaneously as surgical removal would. Additionally, topical creams don’t work on all types of actinic keratoses – some are resistant to the topical creams.
It should also be noted that the application of some topical creams, such as those creams with anti-inflammatory agents, are not painless, as the irritation and redness of the precancerous lesions can cause a fair amount of pain.5 However, the pain is still less than having each lesion surgically removed, so it is still a better alternative when you have multiple actinic keratoses.
Topical Treatments Provide Effective Treatments for Precancer
There are many topical creams available today that provide patients with added weapons in the fight against precancer to prevent it from turning into skin cancer. These creams also enable patients who have multiple precancer lesions on their skin to avoid the pain of having to have each lesion removed. Adding in the facts that the creams can be applied easily and there is no invasive treatments should definitely encourage people to talk to their doctors about these creams as possible treatments if they are dealing with precancerous skin lesions.
References
1 Treatment: Actinic Keratosis. (2007, May 4). From University of California, San Francisco School of Medicine: www.dermatology.ucsf.edu/skincancer/General/treatment/Actinic_Keratosis.aspx
2 East Bay Skin Cancer Center – Jeffrey T. Bortz, M.D. – Dermatology. (2006). From East Bay Skin Cancer Center: www.dermclinic.com/html/skin-keratoses.html
3 Fluorouracil Topical. AHFS Consumer Medication Information (2008 September 1). Retrieved From PubMed Health: www.ncbi.nlm.nih.gov/pubmedhealth/PMH0000293/
4 Precancerous Illustration – Marshfield Clinic Health News. (2005). From Marshfield Clinic: www.marshfieldclinic.org/patients/?page=cattails_2005_mayjun_precancerousimage
5 Precancerous Sun Damage Treatment – Marshfield Clinic Health News. (2005). From Marshfield Clinic: www.marshfieldclinic.org/patients/?page=cattails_2005_mayjun_precancerous
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