Chemotherapy

Topical treatment with mechlorethamine or PUVA.

Topical treatment with mechlorethamine or PUVA.

This form of treatment may be used palliatively or to supplement therapeutic approaches directed against nodal or visceral disease. Topical application of mechlorethamine has produced regression of cutaneous lesions, with particular efficacy in early stages of disease. The overall complete remission rate is related to skin stage; 50% to 80% of TNM classification T1 patients, 25% to 75% of T2 patients, as many as 50% of T3 patients, and 20% to 40% of T4 patients have complete responses. The overall complete remission rate in 243 patients was 64% and was related to stage; as many as 35% of stage IV patients had complete responses. Treatments are usually continued for 2 to 3 years. Continuous 5-year DFS may be possible in as many as 33% of T1 patients.[4,22,23]

Pralatrexate (folate analogue).[24,25]

Pralatrexate (folate analogue).[24,25]

Chemotherapeutic agents generally yield short durations of response. In a retrospective review of 198 patients with advanced-stage disease, the median TTNT was 4 months.[26]

Pegylated liposomal doxorubicin.[27-29]

Systemic chemotherapy: chlorambucil plus prednisone, mechlorethamine, cyclophosphamide, methotrexate, and combination chemotherapy.[26,30-32]