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Intra-lesional Methotrexate For the Treatment of Squamous Cell Carcinoma, Squamous Cell Carcinoma In-Situ, and Keratoacanthoma: How Co-morbidities Correlate With Recurrence
Halka J, Leberfinger A, Diulus L, Pennington G
Summa Health Plastic Surgery
2023-01-27
Presenter: Joshua Halka
Affidavit:
Joshua Halka submitted the IRB proposal, gathered data, and wrote the abstract
Director Name: Ananth Murthy
Author Category: Resident Plastic Surgery
Presentation Category: Clinical
Abstract Category: General Reconstruction
Introduction:
Intra-lesional methotrexate (il-MTX) is a viable option for the treatment of Squamous Cell Carcinoma (SCC), Squamous Carcinoma-in-situ (SCCis), and Keratoacantoma (KA) in patients who are deemed poor candidates for wide local excision (WLE).
Methods:
162 patients diagnosed with KA, SCC, or SCCis who were deemed poor candidates for conventional surgical therapy and underwent treatment with il-MTX from 2015 to 2021 were included in the study. Patients were treated according to our protocol for using il-MTX; the cutaneous lesions underwent shave excision, curettage, and cauterization, followed by injection of MTX into the base of the lesion. We collected patient data, including demographics, lesion type, location, MTX dosage and frequency, follow-up, recurrence, need for WLE or re-injection, and complications.
Results:
A total of 162 patients were analyzed by diagnostic outcome type. Participants were screened for a history of CVA, DVT/PE, Peripheral Vascular Disease, Tobacco use, diabetes, COPD, Kidney Disease, or CHF.
Analysis of SCC patients (n=68) resulted in a recurrence case rate of 13% (n=9). SCCis Patients (n=65) experienced a recurrence rate of 9% (n=5). KA patients (n=40) experienced a recurrence rate of 5.0% (n=2). Correlation analysis showed a significant correlation between previous stroke (P-value <0.01) and recurrence of SCC whereas recurrence of KA was associated with a history of renal disease and/or steroid use.
Conclusion:
Intralesional MTX is a low-risk and effective treatment with an acceptable recurrence rate which clinicians can use to treat patients diagnosed with KA, SCCis, SCC who are deemed poor candidates for wide local excision.
