title: Sequential Curettage, 5-Fluorouracil, and Photodynamic Therapy for Field Cancerization of the Scalp and Face in Solid Organ Transplant Recipients.
abstract: BACKGROUND
  Field cancerization with actinic keratoses and squamous cell carcinoma in situ (AK/SCCIS) represents a common therapeutic challenge in solid organ transplant recipients (SOTRs). These patients often show inadequate responses to methods traditionally used as monotherapy (e.g., topical chemotherapy).
  
  
  OBJECTIVE
  To describe the clinical outcomes and feasibility of a sequential approach to treatment of field cancerization in SOTRs.
  
  
  METHODS
  Four SOTRs with field cancerization of the scalp and/or face were treated using a sequential approach. Light curettage of hypertrophic lesions was followed by application of 5-fluorouracil 5% cream twice daily for 5 days and photodynamic therapy (PDT) with 1-hour incubation on day 6. Pain level during and after PDT was recorded. Photographs were obtained immediately before and after treatment and at follow-up appointments.
  
  
  RESULTS
  All 4 patients tolerated this approach well and demonstrated excellent responses to treatment with complete or near-complete clinical resolution of AK/SCCIS lesions. Patients remained free of AK/SCCIS based on clinical examination 1 to 6 months after treatment.
  
  
  CONCLUSIONS
  For SOTRs with field cancerization, sequential therapy represents a viable therapeutic regimen with good tolerability and durable clinical response. This approach warrants further investigation to determine which therapeutic combinations have optimal tolerability and efficacy.
authors.affiliation: *Department of Dermatology, Mayo Clinic Florida, Jacksonville, Florida; †Department of Dermatology, Brigham and Women's Faulkner Hospital, Jamaica Plain, Massachusetts.
authors.forename: Anokhi
authors.initials: A
authors.lastname: Jambusaria-Pahlajani
authors.forename: Stephanie
authors.initials: S
authors.lastname: Ortman
authors.forename: Chrysalyne D
authors.initials: CD
authors.lastname: Schmults
authors.forename: Christine
authors.initials: C
authors.lastname: Liang
mesh_terms: D000964:Antimetabolites, Antineoplastic / Q000627:therapeutic use*; D002278:Carcinoma in Situ / Q000628:therapy; D002294:Carcinoma, Squamous Cell / Q000628:therapy; D003131:Combined Modality Therapy; D003475:Curettage; D005153:Facial Neoplasms / Q000628:therapy*; D005472:Fluorouracil / Q000627:therapeutic use*; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D055623:Keratosis, Actinic / Q000628:therapy; D016377:Organ Transplantation; D010778:Photochemotherapy; D012307:Risk Factors; D012535:Scalp; D012878:Skin Neoplasms / Q000628:therapy*; D016896:Treatment Outcome
chemical_list: D000964:Antimetabolites, Antineoplastic; D005472:Fluorouracil