Carmustine (BCNU)
Brand name: BiCNU®

Carmustine is a cancer chemotherapy and works by the same mechanisms as nitrogen mustard (NM); however, in current practice, carmustine is rarely, if ever, selected as an alternative to NM..  Topical application of carmustine has also been shown to be effective in the treatment of patch/plaque cutaneous T-cell lymphoma (CTCL).  

Usually, Carmustine is applied only to affected lesions. Topical Carmustine is usually prescribed in 12-week courses. Because Carmustine has been shown to be absorbed into the bloodstream, when used in high concentrations, blood counts may be taken throughout the course of therapy. Rarely does one see a decrease in the blood counts with use of topical Carmustine at lower concentrations.

Patients who have the best therapeutic effect usually experience reddening within the first several weeks of treatment. Treated lesions may become hyperpigmented throughout the course of treatment. In addition, a frequent side effect is the development of fine, dilated blood vessels (telangiectasias) in the treated areas. Most of the telangiectasias will resolve after therapy; however, there are cases in which there is no resolution of the telangiectasias.

After 12 weeks of therapy, patients are evaluated and additional courses may be recommended at the discretion of the treating physician. Topical Carmustine may be combined with systemic agents in some cases of advanced stage disease.