JAAD Study Asks: Can Intralesional 5-FU Intervals Stretch in Low-Risk SCC?
Updated
The Journal of the American Academy of Dermatology will publish a retrospective cohort study in its November 2026 issue (Volume 95, Issue 5) examining whether extended treatment intervals of intralesional 5-fluorouracil remain effective in low-risk squamous cell carcinoma.
The paper, authored by Jonathan C. Hwang, Kevin T. Savage, Reethi S. Padmanabhan, and Melissa Pugliano-Mauro, addresses a practical question that dermatologists face every week in clinic: how few visits can an intralesional 5-FU protocol demand before efficacy in low-risk cutaneous SCC suffers?
The study landed in one of dermatology's highest-impact journals. That placement alone signals the question matters.
Why does treatment interval matter for low-risk SCC?
Intralesional 5-fluorouracil has built a role as a nonsurgical option for selected skin cancers, particularly in patients who are poor surgical candidates or who decline excision. Standard injection schedules, however, often require closely spaced office visits — a burden for older patients, rural patients, and anyone juggling transportation or caregiver logistics.
Stretching the interval between injections could cut patient travel and clinic time meaningfully. A patient on a monthly rather than a biweekly schedule, for example, halves the number of trips to the practice over a treatment course. The trade-off has always been whether tumor clearance holds when you space doses further apart.
The takeaway in plain words: fewer visits only counts as progress if the cancer still responds.
What did the study design look like?
The authors conducted a retrospective cohort study — a design that observes outcomes in patients already treated rather than randomizing them prospectively. Retrospective cohorts can capture real-world practice patterns across larger groups and longer follow-up than many trials manage, though they carry the usual limitations of selection bias and missing data.
The population of interest was patients with low-risk squamous cell carcinoma, a category generally defined by tumor size, location, and histologic features that predict a low probability of recurrence or metastasis. The intervention under review was intralesional 5-fluorouracil delivered at extended treatment intervals, with the investigators evaluating whether efficacy held under the modified schedule.
The full efficacy figures, cohort size, and clearance rates appear in the published article in JAAD Volume 95, Issue 5, and clinicians should consult the primary text for the outcome data.
The takeaway: this is real-world evidence about scheduling, not a new drug or indication.
Who should pay attention?
Dermatologists who treat cutaneous SCC in older, medically complex populations have the most at stake here. Any protocol change that maintains clearance rates while reducing visit frequency affects scheduling templates, chair time, and patient adherence simultaneously.
The study also contributes to a broader conversation about de-escalating intensity in low-risk disease — matching treatment burden to actual tumor risk rather than defaulting to the most intensive schedule.
The takeaway: scheduling evidence may seem modest, but it changes how practices actually run.
What comes next?
As the November 2026 issue reaches readers, expect the findings to feed into practice conversations about injection protocols for nonsurgical SCC management, and potentially to seed prospective studies that test extended intervals under controlled conditions.
Source: Journal of the American Academy of Dermatology (Elsevier)
Daniel Okafor
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Staff writer covering people, launches and day-to-day practice in Clinical dermatology, inflammatory skin disease and biologics at Derm Field.