Vitamin C And Basal Cell Carcinoma

Vitamin C And Basal Cell Carcinoma

To the Editor: Vitamin C, also known as ascorbic acid, is mostly known as an antioxidant molecule.

In the past decade a growing body of experimental data suggests that high-dose ascorbic acid can lead to the generation of intracellular hydrogen peroxide and consequently may function as a source of free radicals.

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• Chen Q.
• Espey M.G.
• Sun A.Y.
• et al.

Ascorbate in pharmacologic concentrations selectively generates ascorbate radical and hydrogen peroxide in extracellular fluid in vivo.

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• Scopus (446)
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Interestingly, the anticancer effect of ascorbic acid is fairly specific to cancer cells and has little effect on normal cells.

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Currently there are several clinical trials revisiting the possible role of intravenous ascorbic acid in various cancers.

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• Welsh J.L.
• Wagner B.A.
• van'tErve T.J.
• et al.

Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial.

• Crossref
• PubMed
• Scopus (164)
• Google Scholar

In this study, we set out to investigate if topical delivery of concentrated ascorbic acid solution is effective to treat basal cell carcinoma (BCC).

This study was approved by the institutional review board of Semmelweis University (80-3/2010) and carried out in accordance with principles of the Declaration of Helsinki.

A total of 7 BCCs (1 nodular and 6 superficial; located on the back [5], chest [1], and shoulder [1]; size 7-20 [mean 12] mm) in 6 patients (5 men, 1 woman; ages 72-81 [mean 74.5] years) were treated once daily with topical saturated ascorbic acid solution (33 g/100 mL water). Target lesions were covered with 0.1-0.2 mL of the solution and a plastic applicator was used to apply some precipitate. An occlusive bandage was then placed for 12 hours. In 6 of 7 cases, treatment was continued for 22 weeks. In 1 case, because of excellent clinical response, the treatment was terminated at week 13. Posttreatment biopsy specimen showed tumor-free tissue in 1 nodular and 4 of 6 superficial BCCs, whereas 2 superficial BCCs showed residual tumor cells and were subsequently excised. In the tumor-free group, histology found a lymphohistiocytic infiltrate in 1 case, and scar formation in 4 other individuals. Local skin irritation confined to the treatment site (erythema with itching and burning) was regularly noted in tumor-free patients, whereas 2 of the nonresponders had mild irritation and an absence of inflammation suggesting treatment noncompliance, which likely hindered a positive treatment outcome. Indeed, noncompliance (skipping daily treatment several times) was confirmed in 1 case. All patients with histologically tumor-free posttherapy biopsy specimens were regularly (every 3 months) monitored for any potential clinical relapses. Over an 18-month observation period, 1 superficial BCC recurred adjacent to the resolved BCC, as confirmed by histology. In summary, of the 7 treated lesions a total of 4 tumors resolved (1 superficial BCC after 13 weeks, 1 nodular and 2 superficial BCCs after 22 weeks), whereas in 1 histologically tumor-free patient tumor recurrence was evident within an 18-month follow-up period. Figs 1 and 2 show clinical improvement and histologic changes in a nodular BCC treated with ascorbic acid solution.

Fig 1 Clinical improvement of a nodular basal cell carcinoma (BCC). A, Marked clinical border of nodular BCC before therapy initiation. B, Red-labeled site of diagnostic punch biopsy (red arrow). C, Clinical picture of treated lesion before posttreatment biopsy. D, Post-therapy punch-biopsy (black arrow) and red marking of the first diagnostic punch-biopsy (red arrow). E, Clinical picture at 18-month follow-up visit.

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Although antitumor efficacy of vitamin C has been disputed, results of recent studies suggest reconsideration of its potential role in cancer therapy.

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^,

⁵

• Welsh J.L.
• Wagner B.A.
• van'tErve T.J.
• et al.

Pharmacological ascorbate with gemcitabine for the control of metastatic and node-positive pancreatic cancer (PACMAN): results from a phase I clinical trial.

• Crossref
• PubMed
• Scopus (164)
• Google Scholar

Limitations of our study include a small sample size and a lack of control group. Nevertheless, based on our encouraging clinical results and given the simplicity and low price of this treatment regimen, we believe that further investigation is warranted. Future studies may also shed light on the precise antineoplastic mechanism of topical vitamin C. Hydrogen peroxide–driven, and indirect, inflammation-related effects (similar to the antitumor effect of topical imiquimod) may be involved simultaneously.

We would like to acknowledge Drs Yvonne Chiu and Glenn Krakower for their guidance and Dr Jared Brown for reviewing the manuscript.

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Article Info

Footnotes

Drs Holló and Jókai contributed equally to this letter.

Dr Németh is currently affiliated with the Department of Dermatology, Medical College of Wisconsin, Milwaukee.

Funded by the Hungarian Scientific Research Fund ( NOTKA 114460 ) and the Semmelweis University Dean's Research Award 2015.

Conflicts of interest: None declared.

Identification

DOI: https://doi.org/10.1016/j.jaad.2016.04.003

Copyright

© 2016 by the American Academy of Dermatology, Inc.

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Vitamin C And Basal Cell Carcinoma

Source: https://www.jaad.org/article/S0190-9622(16)30032-9/fulltext