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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‐flourouracil (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 (&agr;)‐2, 83% for IFN &agr;‐2a, and 100% for IFN &agr;‐2b. Estimated costs (excluding medication cost) ranged from $205 (intralesional methotrexate for keratoacanthoma) to $1,174 (IFN &agr;‐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.