Inflammatory Cure

MEDICINE

CANCER

Cancer of a single small area of the skin is usually not a serious disease --X rays and surgery have achieved a cure rate of at least 98%. Yet all skin cancer cannot be lightly dismissed. Each year it claims 80,000 new victims and causes 4,000 deaths in the U.S., largely because some forms are highly malignant and remain virtually incurable. To make matters worse, the easily curable forms sometimes recur in numbers, and if they are not removed, they, too, be come lethal. For patients who have many superficial skin cancers, in which surgery or radiation is impossible or would be too disfiguring, a New York researcher described a new chemical treatment last week that is as simple as it is effective.

Familiar But Unfamiliar. The two types of cancer involved are called basal-cell and squamous-cell carcinomas, from the types of skin cells among which they are found. For patients who had widespread forms of either of these cancers, Dermatologist Edmund Klein of the Roswell Park Memorial Institute in Buffalo tried using familiar anticancer chemicals--but he used them in an unfamiliar manner.

These drugs, of which the best-known are 5-fluorouracil and methotrexate, are given by mouth or injection to get them into the bloodstream for the treatment of deep-seated tumors. But while they kill cancer cells, they also damage many normal cells; the patient may suffer such severe side effects that their use is generally restricted to far-advanced, near-hopeless cases.

Dr. Klein figured that with localized application he could keep the drugs out of the bloodstream and use them on skin cancers without any of the dangerous side effects. Cautiously, he injected minute doses between layers of the skin, or applied the drugs in ointments and creams. From the beginning, he got an encouraging and prompt response. Furthermore, a number of the drugs he was testing seemed to sensitize the patients' skin, particularly in the cancerous areas. Subsequent applications then caused a bright red, allergic-type reaction. As the dosage was repeated, the reaction got stronger, and selectively destroyed cancer cells, leaving normal cells unharmed. The cancerous growths soon disappeared. Healthy skin grew over the areas with a minimum of scarring.

Clue to Prevention. The inflammatory reaction after a sensitizing dose is so strong, Dr. Klein told the Medical Society of the State of New York, that it even shows up cancers too minute to be detected by other means. Thus it makes prevention possible by revealing places where precancerous cell changes have just begun. The basis for this effect is not yet understood, but it is being investigated at other cancer centers where the treatment is being tested.

Dr. Klein offered two warnings. Doctors must not use the cancer-killing ointments until they are sure just what form of the disease they are dealing with. The ointments do no good against melanoma, for example, and their misuse could lead to fatal neglect of this highly malignant cancer. Nor should they be used on the patient with a single, isolated basal or squamous cell carcinoma, because these cases are treated more effectively, and more simply, by X rays or surgery.

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