Use of clamping to enhance intralesional bleomycin therapy for nodular basal cell carcinoma

R egional chemotherapy usually involves using intra-arterial or intracavitary drug infusion to increase drug concentration within tumor-containing tissue while minimizing systemic toxicity. It has long been used as a treatment modality for various malignancies including melanoma, soft tissue sarcoma, and primary brain tumors. Analogous to regional chemotherapy, intralesional chemotherapy has been used to maximize drug concentrations within tumor-containing cutaneous tissues for the treatment of basal cell carcinoma. However, intralesional chemotherapeutic agents usually require multiple injections over time to achieve histologic clearance of basal cell carcinoma. For example, 9 to 10 injections of interferon alfa-2b and 6 injections of sustainedrelease 5-fluorouracil were used to achieve histologic cure rates of 67% to 86% and 91%, respectively. Electroporation has been used to increase the efficacy of intralesional bleomycin therapy so that a single injection can result in a 94% clearance rate of basal cell carcinoma. However, electrochemotherapy requires expensive equipment that may not be accessible to most physicians. A more practical method of reducing the number of injections required to achieve therapeutic cytotoxicity is to increase the duration of exposure to chemotherapy by mechanically isolating the area around the basal cell carcinoma.