title: Neoadjuvant intralesional methotrexate in cutaneous squamous cell carcinoma: a comparative cohort study.
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).
  
  
  OBJECTIVE
  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.
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: R
authors.initials: R
authors.lastname: Salido-Vallejo
authors.affiliation: Department of Pharmacy, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: I
authors.initials: I
authors.lastname: Cuevas-Asencio
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: G
authors.initials: G
authors.lastname: Garnacho-Sucedo
authors.affiliation: Department of Pathology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: González-Menchen
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: C
authors.initials: C
authors.lastname: Alcántara-Reifs
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: S
authors.initials: S
authors.lastname: De la Corte-Sánchez
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: A
authors.initials: A
authors.lastname: Vélez
authors.affiliation: Department of Dermatology, Hospital Universitario Reina Sofía, Córdoba, Spain.
authors.forename: J C
authors.initials: JC
authors.lastname: Moreno-Giménez
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy*; D017024:Chemotherapy, Adjuvant; D015331:Cohort Studies; D005260:Female; D006801:Humans; D015552:Injections, Intralesional; D008297:Male; D008727:Methotrexate / Q000008:administration & dosage / Q000627:therapeutic use*; D012878:Skin Neoplasms / Q000188:drug therapy*
chemical_list: D008727:Methotrexate