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Procedure · Physical / chemo

Electrochemotherapy (ECT)

Electrochemotherapy combines bleomycin (or cisplatin) with locally applied electrical pulses (electroporation) to enhance drug uptake into tumour cells, dramatically increasing cytotoxicity. NICE IPG446 covers ECT for metastases in the skin from tumours of non-skin origin and melanoma; it should not be cited as NICE endorsement for primary BCC. ECT is particularly useful for symptomatic cutaneous metastases and selected specialist-centre cases where local tumour control is needed.

CurrentLast reviewed 18 May 2026

Indications

  • Cutaneous and subcutaneous metastases from non-skin primary tumours and melanoma (NICE IPG446 scope).
  • Symptomatic palliation of bleeding, painful, ulcerated or fungating cutaneous metastases.
  • Selected specialist-centre use for locally recurrent or inoperable primary skin cancers may be discussed at SSMDT, but should be described as outside the IPG446 primary indication unless a separate source is cited.

Technique

  1. Tumour mapping; usually under general anaesthesia for multiple lesions.
  2. Bleomycin given IV (15,000 IU/m²) — works within 8 minutes.
  3. During the 8–28 minute window: apply electroporation electrodes to each tumour. Brief, intense electrical pulses transiently permeabilise cell membranes.
  4. Single session usually; repeat at 6–8 weeks if residual disease.

Outcomes

  • Complete response rates 60–80% in cutaneous metastases (lesion-level).
  • Effective regardless of tumour histology.
  • Durable local control in many.

Adverse events

  • Local: pain (less if GA), erythema, oedema, ulceration, scarring.
  • Bleomycin: pulmonary toxicity (cumulative dose limited), febrile reactions.
  • Hyperpigmentation.

References

  1. Marty M et al. Electrochemotherapy: results of ESOPE trial. Eur J Cancer Suppl; 2006.
  2. NICE IPG446. Electrochemotherapy for metastases in the skin from tumours of non-skin origin and melanoma. London: NICE; 2013.

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