Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study
Keywords: 
Intralesional methotrexate (MTX-il)
Neoadjuvant therapy for keratoacanthoma
Cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC)
Issue Date: 
2015
Publisher: 
Wiley
ISSN: 
1468-3083
Citation: 
Salido-Vallejo, R. (Rafael); Cuevas-Asencio, I. (I.); Garnacho-Sucedo, G. (G.); et al. "Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study". European Academy of Dermatology and Venereology. 30 (7), 2015, 1120 - 1124
Abstract
Background: Intralesional methotrexate (MTX-il) has been used as neoadjuvant therapy for keratoacanthoma but has only been utilized in a few isolated cases of cutaneous squamous cell carcinoma as neoadjuvant therapy (cSCC). Objectives: The objective of this study was to evaluate the effectiveness in clinical practice of presurgical MTX-il infiltration to reduce the size of the cSCC. Safety and the impact on subsequent reconstructive surgical techniques was also assessment. Methods: Single, retrospective, observational study of two historical cohorts differentiated in time. Subjects included were diagnosed with infiltrating cSCC. Patients included in group-A received neoadjuvant MTX-il and patients included in group-B underwent scheduled surgery without prior infiltration. Univariate and multivariate analyses were performed. Results: Group-A patients (n = 43) showed an average reduction in the tumour area of 0.52 cm(2) , while in group-B (n = 43), the area increased by 0.49 cm(2) . A multivariate linear regression analysis demonstrated that MTX-il was the only independent variable that significantly reduced the tumour size [mean 42.6% (95% CI: 31.17-54.03)]. Tumours ≥2 cm in size required significantly a lower percentage of complex reconstructions (P = 0.026). Lower lip tumours showed a higher reduction in group treated with MTX-il (P = 0.045). The only complication observed was discomfort during methotrexate infiltration (60.47%). Conclusions: Neoadjuvant MTX-il reduced the presurgical size of cSCC lesions and could simplify their subsequent surgery.

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