I had a patient with extensive AK on the face with an SCC on the Lt upper chest.
He is to have a biopsy the next week. On arrival I noticed an unusual hyperemia under dermoscopy . So I did not perform the biospy.
Could there be a possibility of immune reaction elicited by Efudix to attack other SCC related cancers?
Hyperemia is an expected reaction of 5-FU cream because this drug is a cytostatic that kills tumor cells but can also affect healthy tissue if it is put in contact. Hyperemia can turn into ulceration if the contact persists for a long time. However, this reaction is reversible although it may leave some scar or depigmentation if there was a post-treatment ulcer.
Hi
5-FU is a DNA chain terminator, so it will cause apoptosis in the cancer cell. Often, these apoptotic bodies are scavenged by APC (Dendritic Cells and Macrophages), which can present these antigens to T cells for specific cyotoxicty. We call this phenomena "Immune Epitope Spreading".
See attached paper
The patient may have dihydropyrimidine dehydrogenase deficiency. That may cause decreased drug clearance and increased chance of toxicity.
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