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Case Reports
. 2021 May 21;13(5):e15148.
doi: 10.7759/cureus.15148.

Cryotherapy-Enhanced Chemowrap Treatment of Squamous Cell Carcinoma: A Case Series

Jason T Bard  1 , Heather A Kornmehl  1 , Lawrence K Chang  1   2
Affiliations
Case Reports

Cryotherapy-Enhanced Chemowrap Treatment of Squamous Cell Carcinoma: A Case Series

Jason T Bard et al. Cureus. .

Abstract

An estimated 20% of all malignant cutaneous neoplasms are diagnosed as squamous cell carcinoma (SCC). Chemotherapeutic wraps, or chemowraps, consist of application of topical 5-fluorouracil (5-FU) 5% cream along with occlusive zinc oxide and a compressive bandage (e.g., Unna boot). This treatment modality is often used as a less invasive option compared to surgery, especially in the presence of numerous SCCs. Cryotherapy, the use of liquid nitrogen gas, can be utilized to obliterate pre-malignant and malignant skin lesions. In this report, we present four cases in which females between the ages of 65 and 80 with multiple lower extremity SCCs were treated with cryotherapy prior to each chemowrap application, resulting in favorable clinical tumor improvement. Our observations indicate that cryotherapy may enhance the effectiveness of chemowrap treatment when used before each application. To our knowledge, the use of cryotherapy to synergistically enhance the efficacy of chemowraps has not yet been reported. We hypothesize that cryotherapy induces edema and first strips the outer, hyperkeratotic layers of skin, which facilitates deeper penetration of the 5-FU cream from chemowraps. Chemowraps may also relieve the pain associated with cryotherapy. Therefore, dual cryotherapy and chemowrap treatment may be considered to maximize skin penetration, thus minimizing the extent of surgical intervention in patients with a significant number of SCC lesions.

Keywords: 5-fluorouracil; actinic keratosis; chemotherapeutic wrap; chemowrap; cryotherapy; mohs surgery; skin cancer; squamous cell carcinoma (scc); unna boot.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Patient 4 before cryotherapy and concurrent chemowrap treatment.
(A) Posterior view and (B) lateral view. Arrows highlight the sites of interest.
Figure 2
Figure 2. Patient 4 status post eight weeks of cryotherapy with concurrent chemowrap treatment.
(A) Posterior view and (B) lateral view. Arrows highlight the sites of interest.
See this image and copyright information in PMC

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