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GIORNALE ITALIANO DI DERMATOLOGIA E VENEREOLOGIA
A Journal on Dermatology and Sexually Transmitted Diseases
Official Journal of the Italian Society of Dermatology and Sexually Transmitted Diseases
Indexed/Abstracted in: EMBASE, PubMed/MEDLINE, Science Citation Index Expanded (SciSearch), Scopus
Impact Factor 1,014
Giornale Italiano di Dermatologia e Venereologia 1998 April;133(2):87-92
Adjuvant and neo-adjuvant treatment of skin carcinoma with etretinate and interferon
Bottoni U., Richetta A., Silipo V., Innocenzi D., Latini A., Bonaccorsi P., Calvieri S.
Università degli Studi di Roma «La Sapienza» - Roma, Istituto di Clinica Dermatologica (Direttore: Prof. S. Calvieri)
Background. Skin carcinomas are the most frequent human malignant tumors. In 80% of cases these tumors are basal cell carcinomas. Surgery is the elective therapy for skin carcinoma but it sometimes has limits. In these cases chemotherapy may be considered an alternative treatment.
Objective. To verify the efficacy of etretinate with or without alpha-interferon in a group of patients affected by advanced basal or squamous cell carcinomas.
Methods. Patients affected by advanced basal cell carcinoma or squamous cell carcinoma, relapsing or with multiple tumors, were treated with etretinate with or without recombinant-alpha-interferon. In all patients histological diagnosis and clinical staging were obtained before chemotherapy.
Results. Eighteen patients affected by skin carcinoma were included. Patient mean age was 70 years (range 38-88 years). In 6 patients the tumors were multiple. In 7 cases skin carcinomas had just undergone surgery or electrocoagulation and had relapsed. Fourteen patients were affected by basal cell carcinoma and four patients by squamous cell carcinoma. According to the staging by UICC, all cases presented II-IV stage disease. Etretinate was administrated at the initial dosage of 1 mg/kg/die per os, reduced to 0.5 mg/kg/die after 1 month of therapy. In 6 cases alpha -2a interferon was given intralesionally at the dosage of 1.000.000-1.500.000 IU 2-3 times weekly for 10-15 injections. After three months of treatment the clinical response was evaluated. Six patients had complete response (CR), 11 patients partial response (PR) or minor response (MR) whereas only one patient presented disease progression. The patient with PR or MR underwent surgical operations, achieving CR. In the two years follow-up no relapsing le-sions were observed. Moreover in patients with multiple lesions no new carcinoma was seen. Histopathologic examinations performed on lesions before and after chemotherapy, showed reduction of neoplastic bulge and in six cases no neoplastic cells were found. The adverse effects of the drugs were minor, not life threatening and they did not alter the performance status of the patients.
Conclusions. According to our findings and to the literature the conclusion is drawn that chemotherapy with etretinate and interferon can be considered an useful alternative treatment for very large or multiple or relapsing skin carcinomas, when the efficacy of any surgical treatment may be debatable. Moreover this therapy is not immunosuppressive but immunostimulant, and it is able to prevent the appearance of new tumors.