The Skin You’re In: Compound Topicals and Transdermals for Melanoma and Skin Cancer
Americans are more obsessed than ever with tanning and having a tan as an indicator of health and beauty. Whether we’re catching rays on the beach or by the pool, or chasing a sun-kissed glow in a tanning bed or with tanning lotions during cloudy weather, Americans’ risk for and diagnoses of skin cancer and melanoma have risen dramatically in the past decades since tanning became popular.
One in five Americans will develop skin cancer in their lifetime, and treatments for non-melanoma skin cancers have risen by more than 75 percent since 1992.1
For the nearly five million Americans who are treated for skin cancer each year, compound topicals and transdermal treatments for non-melanoma and melanoma skin cancer can provide important pain management as they go through their treatments. Patients with a skin cancer diagnosis, especially those with a more serious form of melanoma, can be under a lot of stress as they navigate treatment options with the help of dermatologists, oncologists and other physicians—compound medications can ensure that their treatment and pain care are tailored to their needs.
Treating Non-Melanoma Skin Cancer and Malignant Melanoma
Many skin cancer treatments can be harsh for patients, resulting in a residual chronic pain. Compound topicals can be used for dermal healing and pain management after dermatological surgeries, which make up the bulk of skin cancer and malignant melanoma treatments. Compounded medications for treatment of tumors allows for innovation in delivery and effectiveness, while compound medications for pain management promotes greater personalization of each patient’s post-treatment therapy.
For basal cell carcinoma and squamous cell carcinoma, non-melanoma forms of skin cancer, aggressive nonsurgical treatment of the pre-cancerous lesions can sometimes decrease the likelihood of conversion to advanced tumors. Particularly for lesions known as actinic keratoses, topical pharmacologic options can be an effective treatment option. A compound topical called imiquimod has shown promise in treating these types of lesions in studies, as well as formulations such as Fluoroplex and Fluorouracil. The topical nonsteroidal anti-inflammatory drug (NSAID) diclofenac sodium gel is another effective option and is FDA-approved for the treatment of actinic keratoses prior to conversion to advanced tumors.2
Imiquimod has received most of the buzz in the past decade regarding topical and transdermal “in situ” treatments, or non-surgical and non-incision treatments. Typically, in situ treatments have been systemic, including radiation therapy, excision and a surgery called “Mohs surgery” in which skin layers are removed progressively until only cancer-free dermis remains.3
FDA-approved imiquimod is a 5% topical cream and an effective treatment for metastatic melanoma of the skin, which normally proves very difficult to treat. Many patients will undergo surgery, radiation therapy, and carbon-dioxide laser ablation without success in trying to treat metastatic melanoma. Imiquimod, however, despite being developed initially for treatment of genital warts, proved effective in clearing up cancerous lesions from the skin in several studied patients, including an 86-year-old woman with malignant melanoma initially treated with incisions and a 49-year-old man initially treated with a resection and skin graft repair.4
Topical Compounds for Cancer Treatment Pain Management
The effectiveness and benefits associated with compound topical and transdermal skin cancer treatments—including reduced systemic absorption and fewer side effects—makes further research highly likely. Topical and transdermal treatment methods also may not be appropriate for the severity or type of skin cancer or melanoma, or not appropriate for certain patients. They still have a strong role to play in pain management after dermatological surgeries to remove metastasized lesions or after radiation therapy.
Proper pain management is an integral part of cancer treatments. Without keeping patient pain under control, quality of life diminishes significantly and patients can find it more difficult to undergo subsequent rounds of treatments if they are in too much pain. In that same vein, compounding is an integral part of making pain treatments more palatable and effective for patients. Compounded topical analgesics and nonsteroidal anti-inflammatories are commonly prescribed as part of cancer pain management. Compounding allows a physician to ensure the correct dosage and delivery method for the topical pain relief for each patient with minimal systemic effects.5
Studies have also shown compounded transdermal pain treatments can be effective for cancer pain, especially the use of lidocaine patches for neuropathic pain. A study of 97 patients diagnosed with postsurgical postherpetic neuralgia and treated with 5% lidocaine patches showed enough potential for “potent” and “partial” efficacy to support further trials at the 5% level.6
With a diagnosis of skin cancer or melanoma, an alternative to surgery or radiation can be attractive options for both patient and physician. While most cancer treatment regimens are highly individualized, some patients may benefit from customized compound topical and transdermal skin cancer and melanoma treatments. Compound pharmacies can assist physicians with creating customized medications to provide higher-quality care and more options for patients who must undergo treatment regimens for their skin cancer.
Pharmaceutica North America is the premier provider of active pharmaceutical ingredients and compounding kits for health care providers and compounding pharmacies, assisting with compounded medication for treatment of skin cancer, melanoma and more. Contact us to find out more about our bulk ingredients and unit-dose APIs.
- “Skin Cancer Facts,” Feb. 9, 2015, http://www.skincancer.org/skin-cancer-information/skin-cancer-facts ↩
- “Topical Treatment Strategies for Non-Melanoma Skin Cancer and Precursor Lesions,” 2004, http://dermatology.ucsf.edu/pdf/McGillisFein.pdf ↩
- “Treatment options in melanoma in situ: topical and radiation therapy, excision and Mohs surgery,” May 2010, http://www.ncbi.nlm.nih.gov/pubmed/20534080 ↩
- “FDA Approval for Imiquimod,” July 3, 2013, http://www.cancer.gov/about-cancer/treatment/drugs/fda-imiquimod; “Topical Imiquimod in the Treatment of Metastatic Melanoma to Skin,” March 2003, http://archderm.jamanetwork.com/article.aspx?articleid=479198 ↩
- “The Management of Cancer Pain,” 2011, http://prc.coh.org/pdf/MgmtCAPain.pdf ↩
- “Use of lidocaine patches for neuropathic pain in a comprehensive cancer centre,” Sept-Oct. 2009, http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2779156/ ↩