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Intralesional methotrexate injection for treatment of squamous cell cancer
Stephenie Poris MD
Joshua Halka MD
Lewis Diulus III MD
Gary Pennington MD
Summa Health, Akron, OH
2021-01-31
Presenter: Joshua Halka
Affidavit:
The work attached represents the efforts of the stated authors in entirety.
Director Name: Ananth Murthy
Author Category: Fellow Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Background:
Intralesional Methotrexate (MTX) has shown to be safe and effective for the treatment of keratoacanthoma, a skin lesion which can harbor or progress to Squamous Cell Carcinoma (SCC). Our study investigates whether intralesional methotrexate injection can be used for treatment of SCC and in situ disease as well.
Methods:
Patients fell into one of three groups. SCC or SCC in situ, and keratoacanthoma. The decision to inject methotrexate was made by clinical judgement and included advanced age, significant co-morbidities, and difficult anatomic location for wide local excision. The treatment consisted of three separate injections to the pathologic site performed over three weeks. Patients were evaluated on follow-up for treatment failure, resolution, or recurrence of cancer.
Results:
The sample with a designated follow up appointment consisted of 26 subjects, at an average age of 79.5 (SD-10.2) years. Average follow up was 2.0 months (SD-3.2 months). Diagnoses included 4 cases of SCC KA, 11 cases of SCC, and 11 cases of SCCis. Recurrence occurred in two cases (7.6%), whereas complications occurred in 1. There was 1 recurrence case in SCC and SCCis, each, and no significant difference among the groups (p=0.82). The single complication case occurred in the SCCis group and was not significantly difference among groups (p=0.49).
Conclusions:
In our cohort of 26 patients who received MTX for skin cancer, 7.6% had risk of recurrence or incomplete response to treatment. In our clinical practice, MTX is a safe non-surgical management option for SCC and in-situ disease in our defined population.
