Topical hydrogen peroxide as a neoadjuvant treatment in the surgical excision of non-melanoma skin cancers

Introduction: Hydrogen peroxide is used as a topical antiseptic and hemostatic agent. At higher concentrations, it can induce cell death and has recently been reported to be effective in treating seborrheic keratosis. This study examines the effectiveness of topical hydrogen peroxide to shrink non-melanoma skin cancers of the head and neck prior to excision with the goals of minimizing cost and morbidity. Methods: The protocol involves rubbing a solution of 33% hydrogen peroxide into the lesion and a 1 cm border with a cotton tip applicator until blanching is observed. The process can be repeated after one hour and weekly reapplications to a maximum of three times are included in this study group. At one month from the initial application, the remaining lesion is resected with primary closure. The specimen is sent to pathology for histological analysis and final diagnosis. The study will accrue 50 patients with one or more lesions per patient. Measurements of lesion size are recorded by tracing the border on to clear acetate film at each visit. Results: Initial results from first six patients found a range of responses from no size change to no visible lesion remaining for excision. All excised specimens have had negative margins histologically. Summary: Topical hydrogen peroxide is a simple and effective treatment for reducing the size of non-melanoma skin cancers prior to excision.