Efficacy assessment of oxygen flow assisted administration of topical methotrexate (OFA‐MTX5%) for superficial basal cell carcinoma assessed by optical coherence tomography

Abstract Background Oxygen‐flow‐assisted topical administration of 5% methotrexate (OFAMTX5%) was recently described as a painless therapeutic option with good cosmetic results for superficial basal cell carcinoma (sBCC). Objectives To assess the efficacy and cosmetic outcome of OFAMTX5% for small (<2 cm) and large (>2 cm) sBCCs of the trunk. Methods Patients with a least two sBCCs, as diagnosed by clinical, dermatoscopic and optical coherence tomography (OCT) examination, were included. One target lesion was treated 2×/week for 2 weeks. Complete (CR), partial (PR) and no (NR) responses, respectively defined as a total absence, improvement or a similar OCT aspect compared to baseline, were evaluated by OCT at 3 and 12 months postprocedure. Cosmetic outcome was evaluated at 1 year. Results At 3 months in a cohort of 32 patients (mean age: 54 years, min: 44 years, max: 89 years), the small sBCC lesion group presented a 94.4% (17/18) CR and a 5.5% PR (1/18), whereas the large lesion group revealed a CR of 64.3% (9/14) and PR of 35.7% (5/14). At 12 months, 3/14 large lesions presented recurrent sBCC at the border of the target lesion, but none in the small lesion group (0/18). No treatment‐related cutaneous nor systemic adverse events were observed. No OCT changes were noted at 3 and 12 months in control sBCC lesions. Cosmetic results were scored as good and excellent in 19.4% and 80.1%, respectively. Conclusions OFAMTX5% represents an interesting therapeutic alternative for sBCC on the trunk, without pain sensations and treatment‐related adverse effects. The place of OFAMTX5% in the therapeutic armamentarium against sBCC remains to be determined in larger series.