What is the role of DMSO (Dimethyl Sulfoxide) in the treatment of basal cell skin cancer?

DMSO in Dermatology: Limited Role in Basal Cell Carcinoma Treatment

DMSO is not recommended as a primary treatment for basal cell carcinoma according to current clinical guidelines, which instead favor established surgical approaches, radiation therapy, or FDA-approved topical medications.

Standard Treatment Options for Basal Cell Carcinoma

The National Comprehensive Cancer Network (NCCN) and American Academy of Dermatology (AAD) guidelines provide clear recommendations for BCC treatment based on risk stratification:

Low-Risk BCC Treatment Options:

• First-line treatments:
  • Curettage and electrodesiccation (C&E) for non-hair bearing areas 1
  • Standard surgical excision with 4mm margins 1
  • Mohs micrographic surgery for certain anatomic locations 1

High-Risk BCC Treatment Options:

• First-line treatments:
  • Mohs micrographic surgery or complete circumferential peripheral and deep margin assessment 1
  • Standard excision with wider margins 1
  • Radiation therapy for non-surgical candidates 1

Non-Surgical Options for Low-Risk Superficial BCC:

• FDA-approved topical therapies:
  • Imiquimod 5% cream 1
  • 5-Fluorouracil 1
  • Photodynamic therapy 1

DMSO in Dermatology

DMSO has several properties that make it interesting for dermatological applications:

• Functions primarily as a solvent that enhances penetration of other substances through the skin 2
• Has anti-inflammatory, analgesic, and free radical scavenging properties 2
• Is FDA-approved only for interstitial cystitis and as an organ transplant preservative, not for skin cancer 2

DMSO and Basal Cell Carcinoma

There are two main approaches where DMSO has been studied for BCC:

1. As a penetration enhancer for photodynamic therapy:

   • A study using DMSO with aminolevulinic acid and curettage for nodular BCC showed 95% complete response at 17-month follow-up 3
   • This approach included a debulking procedure first, not DMSO alone

2. As a vehicle for ascorbic acid:

   • A small randomized trial (25 patients) compared 30% ascorbic acid in 95% DMSO versus imiquimod 4
   • The ascorbic acid/DMSO solution showed 86.7% resolution at 8 weeks compared to 57.1% with imiquimod 4
   • Fewer adverse effects were noted with the ascorbic acid/DMSO solution 4

Clinical Recommendations

Based on current guidelines and available evidence:

1. For most BCC cases: Surgical approaches remain the gold standard with the highest cure rates 1

2. For patients who cannot or prefer not to undergo surgery:

   • FDA-approved topical treatments like imiquimod should be considered first 1
   • Radiation therapy is an established non-surgical option 1

3. DMSO-based treatments:

   • Not mentioned in current clinical guidelines 1
   • Limited evidence from small studies 4, 3
   • May be considered in clinical trial settings or when standard approaches have failed

Important Considerations

• Diagnosis confirmation: Always obtain histological confirmation before any treatment
• Risk stratification: Assess tumor characteristics (size, location, histology) to determine appropriate treatment
• Follow-up: Regular monitoring is essential regardless of treatment choice
• Patient factors: Age, comorbidities, and patient preference should be considered

While emerging research on DMSO combinations shows promise, particularly with ascorbic acid 4 or as a penetration enhancer for photodynamic therapy 3, these approaches are not yet incorporated into clinical guidelines and should not replace established treatments with proven long-term efficacy and safety.