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Intralesional methotrexate (il-MTX) has been used in cutaneous squamous cell carcinoma (cSCC) achieving important reductions in tumor size. However, there is a lack of controlled studies on this regard. The primary objective was to analyze the effect of il-MTX on tumor size in cSCC. As a secondary objective, we evaluated its impact on the surgical approach. We conducted a prospective cohorts study that included 200 patients with histologically confirmed cSCC. Patients in Group 1 (Cases) received neoadjuvant treatment with il-MTX prior to surgery. Patients in Group 2 (Controls) underwent scheduled surgery without prior neoadjuvant therapy. Clinical measurements of lesions were made at the time of inclusion in the study and before surgery. No intergroup statistical differences were found between the assessed variables. In Group 1, tumor size reduction occurred in 93% of the patients after il-MTX therapy. Tumor surface was reduced by 54%. Complex reconstructions were needed in 15% of these patients. In Group 2, tumor surface increased by 33.1% and complex reconstructions were needed in 40% of patients. Intergroup differences were statistically significant (p < 0.001). Neoadjuvant Il-MTX therapy achieves very important tumor size reduction and significantly simplifies surgical treatment., (© 2021 Wiley Periodicals LLC.)

Intralesional methotrexate (il-MTX) has been reported as a useful therapy in keratoacanthoma (KA) and cutaneous squamous cell carcinoma (cSCC). However, the data available on the histological changes induced by this therapy are very scarce. We conducted a single center, prospective study that included 65 cases of cSCC treated with il-MTX before surgical treatment. Two histological studies were conducted in all patients: before intralesional treatment and after surgical removal. Lesions were assessed longitudinally both clinically and histologically. 60 patients (92.3%) responded to il-MTX treatment. There were no differences regarding aggressive histological features of the cSCC between responder and non-responder patients. All cases showed a chronic inflammatory infiltrate after il-MTX. Intratumoral necrosis areas were frequently observed. All cases showed local fibrosis with fine thickening of collagen bundles. Il-MTX induces a chronic lymphohistiocytic inflammatory reaction in both clinical responder and nonresponder patients. Tumor involution after il-MTX is followed by a fine fibrosis that explains the great cosmetic results and improves the accuracy of the follow-up., (© 2020 Wiley Periodicals LLC.)

Background: Intralesional methotrexate (il-MTX) has been used as neoadjuvant therapy for cutaneous squamous cell carcinoma (cSCC) but studies on its effects on tumor thickness are lacking., Objective: The objective of this study was to evaluate il-MTX response with ultrasound examination., Methods: The authors conducted a prospective study in 40 patients with histologically confirmed cSCC. Neodjuvant il-MTX therapy was administered before surgery. Ultrasound evaluation was performed before the first infiltration and before surgical treatment., Results: Response to neoadjuvant treatment was observed in 92.5% of patients, both clinically and sonographically. There was a good correlation between both types of measurements, with r = 0.892 for the minor diameter and r = 0.944 for the major diameter (p < .001). The authors found an ultrasound overestimation compared to the clinical measurements in 92.5% of patients (mean overestimation: 1.08 mm). There was a good correlation between ultrasound and histological measurements in tumor thickness with r = 0.932 (p < .01), with an ultrasound overestimation in 97.5% of cases (mean overestimation: 0.90 mm)., Conclusion: Neoadjuvant il-MTX can reduce not only surface tumor dimensions but also tumor thickness. Ultrasound improves treatment response control with greater accuracy than clinical assessment alone.