A simple cream could eventually replace the surgeon’s scalpel as an effective mass treatment for the most common type of skin cancer.
A clinical trial funded by Cancer Research UK will investigate the effectiveness of imiquimod cream on basal cell carcinoma (BCC) – the most common form of non-melanoma skin cancer.
It is hoped the five year trial will prove that home treatment of skin cancer could become a reality. The cream was originally used as a treatment for genital warts. It works by boosting the anti-tumour response locally – a method of attack which works effectively against the warts and may also destroy this type of cancer.
Surgery is the current best method of removing BCCs and is likely to remain the most reliable treatment for more advanced cases.
However the trial’s lead researcher Dr Fiona Bath points out that, if successful, the cream could be an effective way of dealing with many people with straightforward BCCs.
“One of the main advantages of the cream is that it would provide a better cosmetic result than surgery as there will be no scarring. We hope imiquimod will offer patients a simple alternative to surgery,” says Dr Bath.
Skin cancer is the most common form of cancer in the UK. There are around 60,000 non-melanoma skin cancer cases reported every year, although Cancer Research UK experts believe the true figure is nearer 100,000 cases. This obviously places significant pressure on the 348 dermatologists in the UK.
The discrepancy in number of cases is due to many cancer registries in the UK not registering BCCs or doctors not reporting them.
Professor Hywel Williams, principal investigator for the trial, adds: “Home application means the patient saves repeated trips to a cancer centre, it avoids a surgical procedure and the frustration of sitting on a waiting list.
“An added benefit is that it could save the NHS money and free up dermatologists to tackle more difficult BCCs.”
In the US and Australia incidence of BCC has doubled approximately every 14 years. Small scale imiquimod trials in these two countries have shown between 73 per cent and a 100 per cent clear up rate for the cream when applied at least once daily.
“The number of patients being diagnosed with BCC is rocketing and this cream offers a potentially cost effective method of easing that burden,” adds Dr Bath.
The 3-centre trial will be coordinated from the Centre of Evidence-Based Dermatology, Queen’s Medical Centre, University of Nottingham.
Basal cell skin cancer is the commonest type of skin cancer – accounting for 75 per cent of non-melanoma skin cancers diagnosed. This cancer develops from basal cells, which are in the deepest layer of the epidermis. It develops mostly in areas exposed to the sun.
Prolonged sun exposure is a major cause and those particularly at risk include men, people with fair skin, red hair, blue eyes, Celtic ancestry and a tendency to freckle.
If BCC is left untreated, it can develop into a rodent ulcer. This is a deep ulcer in the skin that can spread – eating away body tissues that surround it. However advanced rodent ulcers are rare in the UK.
Sir Paul Nurse, Chief Executive of Cancer Research UK, says: “This treatment could offer many potential benefits. Home treatment would be easier and less stressful for patients and reduce pressure on dermatology departments. We will also be undertaking studies to examine why this form of cancer is rising so rapidly and what we can do to help prevent it.”
The cream used will be imiquimod 5%
Skin cancers can appear as:
- A new growth or sore that does not heal within 4 weeks
- A spot or sore that continues to itch, hurt, scab, crust or bleed for more than 4 weeks
- Areas where the skin has broken down or ulcerates with no other obvious cause
The trial is now fully staffed and the recruitment of patients will begin in 2003.
The trial will run from three centres – The Queen’s Medical Centre University Hospital, Nottingham; Solihull district general hospital; Chesterfield district general hospital.