All Title Author
Keywords Abstract

Treatment of Basal Cell Carcinoma by Topical 25% Podophyllin Solution

DOI: 10.4236/jcdsa.2015.53023, PP. 189-197

Keywords: BCC, Podophyllin, Topical Therapy

Full-Text   Cite this paper   Add to My Lib


Background: Basal cell carcinoma is the most common malignancies of the skin. Numerous modalities of treatment are available. Podophyllin is an antimitotic and caustic agent that has been used in treatment of genital warts. Objective: To test the effectiveness and safety of topical 25% podophyllin in treatment of basal cell carcinoma. Patients and Methods: Thirty eight patients with basal cell carcinoma enrolled in this open labeled interventional study that had been enrolled in Department of Dermatology-Baghdad Teaching Hospital, Baghdad, from January 2010 to October 2011. History and physical examination was performed to all patients regarding all demographics detail related to the disease. Exclusion criteria: were pregnancy, recurrent tumors, aggressive deep subtypes, morpheaic type, and size more than 2 cm2 in diameter. Biopsies for all patients were done for histopathological examination at the first visit, and after clinical cure of the lesions. Lesions were treated with 25% topical podophyllin solution once weekly for 6 weeks. Follow up after clinical cured was done every 3 months up to 18 months to recording any sign and symptom of recurrent. Results: Thirty five patients with basal cell carcinoma completed the study: 28 (80%) males and 7(20%) females with males to females ratio 4:1, their ages ranged from 30 - 87 (64.114 ± 12.68) years, and the duration of the disease ranged from 2 months to 30 years (6.88. ± 4.83) years. The size of lesions ranged from 0.8 - 1.9 (1.454 ± 0.239) cm. The total podophyllin applications number ranged from 2 - 6 (4.65 ± 1.055) sessions. The total numbers of treated lesions were 100 lesions: 64 (64%) nodular, 31(31%) pigmented, 3(3%) Basosquamous, and 2 (2%) superficial. Ninety six (96%) lesions in 32 patients showed complete cure with 2 - 6 sessions, while 4 lesions in 3 patients showed partial response with 6 sessions. Biopsy from 21 cured lesions in 21 patients showed complete clearness apart from one with residual malignant cells. All the patients did not show clinical recurrence, during the follow up period up to 18 months. Inflammatory


[1]  Mikilineni, R. and Weinstock, M.A. (2001) Epidemiology of Skin Cancer. In: Atlas of Clinical Oncology: Skin Cancer, BC Decker, London, 1-15.
[2]  Akinci, M., Aslan, S., Morkoc, F. and Cetin, A. (2008) Metastatic Basal Cell Carcinoma. Acta Chirurgica Belgica, 108, 269-272.
[3]  Lacour, J.P. (2002) Carcinogenesis of Basal Cell Carcinoma: Genetics and Molecular Mechanism. British Journal of Dermatology, 146, 17-19.
[4]  Kogerman, P., Krause, D. and Rahnama, F. (2002) Alternative First Exons of PTCH1 Are Differentially Regulated in Vivo and May Confer Different Functions to the PTCH1 Protein. Oncogene, 21, 6007-6016.
[5]  Kim, M., Park, H.J. and Baek, S. (2002) Mutations of the P53 and PTCH Gene in Basal Cell Carcinoma: UV Mutation Signature and Strand Bias. Journal of Dermatological Science, 29, 1-6.
[6]  Nouri, K., Christopher, J., Ballard, B.S., Asha R., Patel, B.S. and Brasie, R.A. (2008) Basal Cell Carcinoma. Skin Cancer, The McGraw-Hill Companies.
[7]  Ting, P.T., Kasper, R. and Arlette, J.P. (2005) Metastatic Basal Cell Carcinoma: Report of Two Cases and Literature Review. Journal of Cutaneous Medicine and Surgery, 9, 10-15.
[8]  Hoban, P.R., Ramachandran, S. and Strange, R.C. (2002) Environment, Phenotype and Genetics: Risk Factors Associated with BCC of the Skin. Expert Review of Anticancer Therapy, 2, 570-579.
[9]  Grabski, W.J. and Salasche, S.J. (1998) Positive Surgical Excision Margins of A Basal Cell Carcinoma. Dermatologic Surgery, 24, 921-924.
[10]  Nouri, K., Spencer, J. and Taylor, J. (1999) Does Wound Healing Contribute to the Eradication of Basal Cell Carcinoma Following Curettage and Electrodessication? Dermatologic Surgery, 25, 183.
[11]  Kaur, S., Thami, G.P. and Kanwar, A.J. (2003) Basal Cell Carcinoma-Treatment with Cryosurgery. Indian Journal of Dermatology, Venereology and Leprology, 69, 188-190.
[12]  Mendenhall, W.M., Amdur, R.J., Hinerman, R.W., Cognetta, A.B. and Mendenhall, N.P. (2009) Radiotherapy for Cutaneous Squamous and Basal Cell Carcinomas of the Head and Neck. The Laryngoscope, 119, 1994-1999.
[13]  Tierney, E.P. and Hanke, C.W. (2009) Cost Effectiveness of Mohs Micrographic Surgery: Review of the Literature. Journal of Drugs in Dermatology, 8, 914-922.
[14]  Foley, P. (2005) Clinical Efficacy of Methyl Aminolevulinate Photodynamic Therapy in Basal Cell Carcinoma and Solar Keratosis. Australasian Journal of Dermatology, 46, S8-S10.
[15]  Padgett, J.K. and Hendrix, J.D. (2001) Cutaneous Malignancies and Their Management. Otolaryngologic Clinics of North America, 34, 523-553.
[16]  Kim, K.H., Yavel, R.M. and Gross, V.L. (2004) Intralesional Interferon Alpha-2b in the Treatment of Basal Cell Carcinoma and Squamous Cell Carcinoma: Revisited. Dermatologic Surgery, 30, 116-120.
[17]  Sharquie, K.E., Al-Nuaimy, A.A. and Al-Shmary, F.A. (2005) New Intralesional Therapy for Basal Cell Carcinoma by 2% Zinc Sulphate Solution. Saudi Medical Journal, 26, 359-361.
[18]  Love, W.E., Bernhard, J.D. and Bordeaux, J.S. (2009) Topical Imiquimod or Fluorouracil Therapy for Basal and Squamous Cell Carcinoma: A Systematic Review. Archives of Dermatology, 145, 1431-1438.
[19]  Bianchi, L., Orlandi, A., Campione, E., Angeloni, C., Costanzo, A. and Spagnoli, L.G. (2004) Topical Treatment of Basal Cell Carcinoma with Tazarotene: A Clinicopathological Study on a Large Series of Cases. British Journal of Dermatology, 151, 148-156.
[20]  United State Pharmacopeia Committees (Eds.) (2004) Podophyllin. In: United State Pharmacopeia Committees, Eds., Drug Information for the Health Care Professional, 24th Edition, Rev. US Convention Inc., Thomason Micromedex, 2341-2348.
[21]  Podophyllum (Topical). Know More Be Sure. Update 3 August 2000.
[22]  Katzung, B.G. (1992) Basic and Clinical Pharmacology. 5th Edition, Appleton and Lange, Norwalk, 884.
[23]  Martin, E.C., Christy, L., Cowan, M.C., Marshal, S.W., Dawson, A.H., Seifert, S.A., Schon, W.S., Yip, L., Keyes, D.C., Hurlbut, K.M. and Erdman Arm Dart, R.C. (Eds). (2004) Medical Toxicology. 3rd Edition, Chap. 255, Walters Kluwer Company, Philadelphia, 1690-1691.
[24]  Lin, M.C., Cheng, H.W., Tsai, Y.C., Liao, P.L. and Kang, J.J. (2009) Podophyllin Induced Genotoxicity in Vitro and in Vivo through ROS Production. Drug and Chemical Toxicology, 32, 68-76.
[25]  Rahman, A.U., Ashraf, M., Choudhary, M.I., Rehman, H.U. and Kazmi, M.H. (1995) Antifungal Aryltetralin Lignans from Leaves of Podophyllum hexandrum. Phytochemistry, 40, 427-431.
[26]  Beutner, K.R. and Ferenczy, A. (1997) Therapeutic Approaches to Genital Warts. The American Journal of Medicine, 102, 28-37.
[27]  Moore, M.M. and Strober, B.E. (2008) Topical and Intralesional Cytotoxic Agent. In: Wolff, K., Goldsmith, L.A., Katz, S.I., Gilchrest, B.A., Paller, A.S. and Leffell, D.J., Eds., Fitzpatrick’s Dermatology in General Medicine, 7th Edition, Chap. 220, McGraw-Hill-Company, New York, 2124.
[28]  Habif, T.P. (2004) Sexually Transmitted Viral Infection. In: Habif, T.P., Ed., Clinical Dermatology, 4th Edition, Chap. 11, Mosby Inc., Toronto, 336-342.
[29]  Huber, A., Huber, J.D. and Skinner, R.B. (2004) Topical Imiquimod Treatment for Nodular Basal Cell Carcinomas: An Open-Label Series. Dermatologic Surgery, 30, 429-430.
[30]  Vidal, D., Matias-Guiu, X. and Alomar, A. (2004) Open Study of the Efficacy and Mechanism of Action of Topical Imiquimod in Basal Cell Carcinoma. Clinical and Experimental Dermatology, 29, 518-525.
[31]  Efudex (Fluorouracil) Topical Solution and Cream (Product Pamphlet). ICN Pharmaceuticals, Inc., Costa Mesa, 2000.
[32]  Berman, B., Sullivan, T. and De Araujo, T. (2003) Expression of Fas-Receptor on Basal Cell Carcinomas after Treatment with Imiquimod 5% Cream or Vehicle. British Journal of Dermatology, 149, 59-61.
[33]  Lawrence, C.M. (1999) Mohs Micrographic Surgery for Basal Cell Carcinoma. Clinical and Experimental Dermatology, 24, 130-133.
[34]  Reymann, F. (1979) Treatment of Basal Cell Carcinoma of the Skin with 5-Fluorouracil Ointment. Dermatologica, 158, 368-372.


comments powered by Disqus