Correspondence
Preliminary Observations on the Use of Topical Tazarotene to Treat Basal-Cell Carcinoma
N Engl J Med 1999; 341:1767-1768December 2, 1999
- Article
To the Editor:
Tazarotene is a novel receptor-selective retinoid originally developed for the topical treatment of mild-to-moderate plaque psoriasis.1 On the basis of recent hypotheses about the effects of this agent on the differentiation and proliferation of keratinocytes,2 we performed an open-label clinical trial to evaluate the efficacy and tolerability of topical tazarotene (0.1 percent in gel) in the treatment of basal-cell carcinoma.
Patients were not eligible for treatment if they had received any therapy for basal-cell carcinoma within four weeks before enrollment in the study. Twenty patients with basal-cell carcinoma (11 men and 9 women; age range, 37 to 85 years; mean age, 66.6 years) were enrolled. Informed consent was obtained from all the patients. A total of 30 lesions (17 nodular and 13 superficial) were treated. Four lesions were recurrent and had previously been treated with surgical excision or topical fluorouracil. The clinical diagnosis of basal-cell carcinoma was confirmed by digital epiluminescence microscopy, which showed arborizing vessels and leaf-like areas3 in all the lesions, and by histopathological examination of 10 lesions. The sites of the lesions included the face (15 lesions), trunk (14), and extremities (1). The size of individual lesions ranged from 0.7 to 5 cm (mean, 1.2). All lesions were treated with tazarotene (0.1 percent in gel, applied once daily) for a maximal period of eight months.
A complete response, defined as the disappearance of basal-cell carcinoma, was achieved after five to eight months of treatment for 16 of the 30 lesions (53 percent) (11 of 13 superficial and 5 of 17 nodular lesions), 3 of which were recurrent (Figure 1Figure 1
Nodular Basal-Cell Carcinoma before and after Treatment with Topical Tazarotene.). Digital epiluminescence microscopy showed no evidence of arborizing vessels or leaf-like areas in successfully treated lesions. Post-treatment histopathological examination of 5 of the 16 lesions with complete responses revealed slight fibrosis of the superficial dermis with no residual neoplastic cells. No recurrence was observed after 4 to 16 weeks of follow-up (mean, 9.6 weeks). A partial response, defined as a clearly visible reduction (>40 percent) in the size of the tumor, was achieved in the other 14 lesions (47 percent). Remarkably, there was neither a lack of response nor a worsening during treatment in any patient. Adverse events were limited to mild local irritation. Routine laboratory tests, performed before and after treatment, showed no abnormalities.The mechanism of action of tazarotene in the treatment of basal-cell carcinoma is not known. Molecular effects similar to those observed in the case of psoriasis may mediate the therapeutic effect reported here for basal-cell carcinoma.
The effectiveness of topical tazarotene (0.1 percent in gel) in the treatment of superficial and nodular basal-cell carcinoma, as demonstrated in our preliminary study, could change the clinical approach to the management of this common malignant cutaneous tumor. Longer-term follow-up for possible late recurrences and treatment of larger numbers of patients will be necessary to evaluate this new therapeutic approach further.
3 ReferencesKetty Peris, M.D.
Maria Concetta Fargnoli, M.D.
Sergio Chimenti, M.D.
University of L'Aquila, 67100 L'Aquila, Italy1
Weinstein GD ,Krueger GG ,Lowe NJ , et al. Tazarotene gel, a new retinoid, for topical therapy of psoriasis: vehicle-controlled study of safety, efficacy, and duration of therapeutic effect. J Am Acad Dermatol 1997;37:85-92
CrossRef | Web of Science | Medline2
Duvic M ,Asano AT ,Hager C ,Mays S . The pathogenesis of psoriasis and the mechanism of action of tazarotene. J Am Acad Dermatol 1998;39:S129-S132
CrossRef | Web of Science | Medline3
Steiner A ,Pehamberger H ,Wolff K . In vivo epiluminescence microscopy of pigmented skin lesions. II. Diagnosis of small pigmented skin lesions and early detection of malignant melanoma. J Am Acad Dermatol 1987;17:584-591
CrossRef | Web of Science | Medline
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