Apply the Best Treatment First
At Equine Medical Solutions Ltd we believe in giving owners the best advice for treating sarcoids of all types at all locations. There are around 40 different treatments used worldwide. Many “sarcoid remedies” have no scientific evidence to support their use.
We base our treatment plans on published evidence of benefit and 30 years of experience in treating all types of Sarcoid.
Lesions that look the same and are in the same anatomical area can respond differently to the same treatment! It is therefore essential to get the correct advice on treatment as soon as you notice a lesion consistent with sarcoid.
Using the wrong treatment often results in the sracoid becoming more aggressive tumour, and will often lead to more sarcoids developing over the horse. Repeated treatment failures will amke it harder to treat the horse so it is essential to select the best possible treatment as the first option.
Sarcoids should be treated at an early stage when the lesions are small. This makes effective treatment more certain particularly if the horse is under 6 years of age.
Neglected lesions will require an extensive and aggressive treatment protocol which may have a big impact on the horse and may not be successful.
Radiation therapy involves placing radioactive material in or around the sarcoid.
This gives by far the best results but is very expensive and only available in two or three centres worldwide.
It is usually reserved for difficult lesions such as around the eye or over joints, and where owners can afford to invest the considerable sums involved.
In the UK the only centre doing this is the Animal Health Trust in Newmarket.
Surgical removal is appropriate for some sarcoids but not for others. In some cases it can make the sarcoid more aggressive and recurrence can occur even many years later. It can carry a high failure rate due to recurrence. We can advise your veterinary surgeon if surgery should be performed.
Smart Surgery can give a very good cosmetic effect but is only suitable in certain locations. This surgery involves a one cut one blade principle to avoid the risk of contaminating the surgery site with tumour cells. Each instrument is repaced after contact with the site. This may add to the cost of the procedure but is money well spent. We provide a leaflet for vets who want to learn how to apply smart surgery principles.
The best prognosis is acheived by selecting amenable lesions (small, well defined and at convenient sites). Generally surgery should be avoided for nodular eye lesions but can be useful in nodular sarcoids in the groin and thigh areas that do not have skin involvement.
If sugery is performed your vet should send away the mass to ensure that there is enough of a margin of normal tissue to minimise the risk of recurrence.
Laser surgery is often used as it reduces the risk of contaminating the side of the wound with tumour cells. It is therefore thought to be better than traditional surgery. However for most sarcoids it will not be possible to close the wound and so healing may be prolonged.
The location and extent of the Sarcoid will determine if the procedure can be done standing (under sedation) or requires a full anaesthetic. The latter can add significantly to the cost.
Surgery is thought to be better if the wound is not sutured afterwards. The open site could however be at risk of re-introduction of sarcoid or infection and will be slow to heal which can be problematic at some sites.
Surgical removal often needs to be combined with other forms of treatment that will reduce the risk of future recurrence.
Cryosurgery refers to the use of freezing to remove a sarcoid. It is only efefctive for small surface lesions. It is quite time consuming as each lesion must be frozen and thawed at least 3 times. The freezing can cause damage to surrounding tissues and extensive scarring. There is a high rate of recurrence with this technique.
Sometimes cryosurgery is combined with traditional surgery to remove the bulk of the lesion. This seems to have result in a minor improvment in prognosis.
Heat cautery can also be used in combination with traditional surgery. It is thought to kill off seeding cells that end up back in the wound site during surgery and may improve prognosis slightly.
Ligation or Tying off the Sarcoid
Ligation or banding the sarcoid can be very tempting when there is a pedicle or stem to the sarcoid. However before this is attempted your vet MUST check if the sarcoid has a root that extends into the deeper tissues. Ligation can be extremely dangerous if there is a root structure and should only be performed by a veterinary surgeon.
Ligation is most suited to Type A1 and B1 nodular sarcoids and some small pedunculated fibroblastic sarcoids.
The sarcoid will die slowly over a few weeks and will then fall off leaving an open wound. The wound can be much larger than expected as the skin draws back from the site.
Ligation is much more successful when combined with topical treatments that will kill the root as well as the superficial mass.
NEVER attempt ligation yourself as it can make matters much worse
There are many topical tratments available. The evidence supporting some of them is limited.
AW5 is a cream developed from the “Liverpool cream or AW4-LUDES cream. It has been used in many thousands of horses with great success.
Bleomycin is a chemotherapy cream which has recently been shown to have great success in treating certain tumour types. It is used in humans to treat skin cancers particularly around the face where surgery would leave scarring.
Efudix (5-Fluoro-uracil cream) is a chemotherapy cream which can be useful in small areas of occult or verrucous sarcoid.
Aldara (Imiquimod) is a cream used in humans to treat genital warts. It requires a long treatment course to be effective
Retinoids (Zorac) helps reduce the wart like surface of the sarcoid. It is usually used in verrucose and occult lesions but seldom results in a cure.
Aciclovir is an antiviral cream which may have some effect in sarcoids where the papilloma virus is thought to have a role.
Exterra/Blood Root Ointment is an extract of plants which is escharotic (caustic or corrosive).
Photodynamic therapy involves applying or injecting a chemical that the tumour cells will absorb. The chemical will then react to certain types of light and cause damage and death of the tumour cells. The chemicals used will also react to sunlight which can create side effects similar to severe sunburn in normal skin when the horse is in sunlight. .
BCG injection involves injection of the vaccine used to prevent tuberculosis (TB) in humans into the sarcoid. This promotes an immune response to the sarcoid. The injection needs to be given at regular intervals and can result in an allergic reaction. Your vet will need to monitor the horse for up to an hour after each injection and may also administer treatments to reduce the allergic reaction. The treatment results in swelling at the site as it takes effect and the treatment course can be quite long. It is particularly useful for sarcoids around the eyes. However there is a worldwide shortage of BCG and so supplies for horse use are extremely limited and expensive.
Intralesional Chemotherapy involves injecting drugs directly into the sarcoid. It carries some health and safety risks and is only available in certain parts of the world for very specific types of sarcoid