Imiquimod Treatment of Superficial and Nodular Basal Cell Carcinoma: 12-Week Open-Label Trial

BACKGROUND: Imiquimod is an immune response modifier shown to be effective in basal cell carcinoma (BCC). OBJECTIVE: To evaluate the efficacy, tolerability, and response durability of imiquimod 5% cream in selected patients with superficial and/or nodular BCCs. METHODS: Seventy-five superficial and 19 nodular BCCs in 49 patients were treated with imiquimod once daily three times a week for up to 12 weeks. RESULTS: Of the 49 enrolled patients, 1 discontinued the study and 1 was lost to follow-up. After 12 weeks of treatment, a complete response occurred in 70 of 75 (93.3%) superficial BCCs and a partial response in 4 of 75 (5.3%) superficial BCCs. Ten of 19 (52.6%) nodular BCCs cleared after 12 weeks, whereas 7 (36.8%) showed partial remission. Adverse side effects were limited to local skin reactions. Recurrence was observed in 2 of 70 (2.9%) successfully treated superficial BCCs 6 and 8 months after treatment discontinuation. No recurrence was detected in 68 of 70 (97.1%) superficial BCCs and in 10 successfully treated nodular BCCs after 12 to 34 months of follow-up (mean 23 months). CONCLUSIONS: In our patient population, treatment of superficial BCCs with topical imiquimod for 12 weeks produced an excellent clinical response overall, with complete remission maintained after a mean of 23 months.     

Treatment of a Large Superficial Basal Cell Carcinoma with 5% Imiquimod: A Case Report and Review of the Literature

BACKGROUND: Large superficial basal cell carcinomas (BCCs) may be difficult to treat surgically due to the potentially large resulting defect after removal. Imiquimod, an immune response modifier, when applied topically, has been demonstrated to be successful in treating superficial BCCs. There is no published experience on the treatment of larger superficial BCCs (greater than 2 cms2) with imiquimod at this time. OBJECTIVE: To assess the clinical and histologic regression, as well as the short- and long-term effects of topical imiquimod on large superficial BCC. METHOD: A 52-year-old white female with a 30 cm2 biopsy proven superficial BCC of 28 years duration on the right dorsal arm was treated with 5% imiquimod three times a week for 12 weeks. Clinical follow-up was conducted 1, 4, 6, and 10 months after treatment, as well as histologic assessment of recurrence at 4 months after treatment. RESULTS: Apparent clinical and histologic clearance was achieved. The treatment was well-tolerated and the patient completed the treatment schedule without a rest period, despite erosion of the lesion in the last week of treatment. CONCLUSION: This report describes the first case of a large superficial BCC (30 cm2) successfully treated with topical imiquimod and with a 10 month follow-up.     

The Use of Imiquimod 5% Cream for the Treatment of Superficial Basal Cell Carcinomas in a Basal Cell Nevus Syndrome Patient

Background. Imiquimod 5% cream has been used effectively to treat superficial basal cell carcinomas (BCCs).
Objective. The purpose of this study is to examine the effectiveness, tolerability, and desirability of imiquimod 5% cream in treating superficial non-facial basal cell carcinomas in a patient with basal cell nevus syndrome.
Methods. Three biopsy-proven nonfacial BCCs were treated for 18 weeks with once daily application of 5% imiquimod cream. The lesions were then removed to search histologically for residual tumor.
Results. The two adequately treated tumors revealed no residual BCC upon removal. Our patient reported that he tolerated the treatment but he would not desire this treatment again based on the length of treatment time and the degree of local inflammation at the treatment sites.
Conclusion. Imiquimod 5% cream appears to be effective in eradicating superficial nonfacial BCCs. The degree of local inflammatory response may affect the patients' tolerability of treatment and therefore patient compliance.     

Topical Imiquimod Treatment for Nodular Basal Cell Carcinomas: An Open-Label Series

BACKGROUND: Imiquimod has been used for basal cell carcinomas (BCCs). This is the first open-label series using imiquimod for nodular BCC with Mohs surgery resection for confirmation of treatment. OBJECTIVE: To evaluate the efficacy of topical imiquimod in patients with biopsy-proven nodular BCC. RESULTS: After 12 weeks for three times a week application, treatment sites at week 15 were surgically excised using Mohs micrographic surgery. All 15 treatment subjects were clear of BCC. At the 18-month follow-up, no patients had recurrent tumor. CONCLUSION: Imiquimod 5% cream may be another treatment modality for nodular BCC.     

Treatment of Bowen''s Disease with Topical 5% Imiquimod Cream: Retrospective Study

BACKGROUND: Topical 5% imiquimod cream is an FDA-approved treatment for superficial basal cell carcinomas. It has also been utilized in the treatment of Bowen's disease (squamous cell in situ). The current literature on this subject, however, is scant, and this treatment is only validated by case reports and two small open label studies. OBJECTIVE: The objective was to assess the efficacy of topical 5% imiquimod cream in the treatment of squamous cell in situ in a larger open-label case series. METHODS A retrospective study of 49 patients was performed. RESULTS: Forty-two of the 49 (86%) patients in the study had a complete response with topical imiquimod. The remaining 7 (14%) failed therapy and required additional treatments. The mean follow-up duration was 19 months, with a range of 1 to 44 months. CONCLUSION: Topical 5% imiquimod cream appears to be clinically beneficial in the treatment of Bowen's disease and should be considered as a treatment option.     

Pilot Study of Imiquimod 5% Cream as Adjunctive Therapy to Curettage and Electrodesiccation for Nodular Basal Cell Carcinoma

BACKGROUND: Curettage and electrodesiccation (C&D) is a widely used method to treat nodular basal cell carcinoma (BCC). However, residual tumor is present immediately after the procedure in approximately 20 to 40% of cases. Imiquimod, a topical immune response modifier that targets Toll-like receptor 7, is currently approved for superficial BCC. OBJECTIVE: In a double-blind, vehicle-controlled study, the administration of imiquimod after C&D was investigated to determine if the combination regimen would reduce the frequency of residual tumor compared with C&D alone in patients with nodular BCC. METHODS: Twenty patients received three cycles of C&D followed by imiquimod 5% or vehicle cream once daily for 1 month as adjunctive therapy. The primary end point was the frequency of residual tumor. The secondary end points included the time to heal and cosmetic appearance. RESULTS : Twenty patients were randomized to the imiquimod (n = 10) or vehicle (n = 10) treatment group. At 8 weeks, the proportion of patients with residual tumor was substantially decreased with imiquimod therapy (10%) compared with vehicle (40%). Wounds in the vehicle group healed more quickly than those in the imiquimod group, although by 8 weeks, all excision sites were healed. The majority of scars in the control group were atrophic and hypopigmented, whereas most scars in the imiquimod group were flat and slightly pink. CONCLUSION: Imiquimod 5% cream once daily for 1 month as adjunctive therapy after C&D substantially reduced the frequency of residual tumor and improved the cosmetic appearance compared with C&D alone. These preliminary results suggest that further studies to investigate imiquimod adjunctive therapy are warranted.     

咪喹莫特治疗婴幼儿血管瘤

目的 探讨咪喹莫特治疗婴幼儿血管瘤( infantile hemangioma,IH)的临床适应证.方法 320例婴幼儿血管瘤,浅表型250例,深在型20例,混合型50例,年龄3～24周,隔日夜间睡前外用5％咪喹莫特乳青涂擦16周,随访至1岁.疗效评价分为6级,1级:完全消退;2级:75％≤消退≤99％;3级:50％≤消退＜75％;4级:25％≤消退＜50％;5级:消退＜25％;6级:未消退或增生.记录局部皮肤反应及全身不良反应.结果 浅表型、深在型、混合型IH的有效率分别为61.2％(153/250)、10.0％ (2/20)、60.0％( 30/50).浅表型和混合型之间比较差异无统计学意义(P=0.874),浅表型与深在型之间比较差异有统计学意义(P＜0.01),深在型与混合型之间比较差异有统计学意义(P＜0.01).咪喹莫特外用后4～8周,IH开始生长控制并出现消退现象.56.0％ (28/50)混合型IH出现深部病灶的增生.皮肤反应主要为红斑、表皮剥落、结痂,程度轻微.结论 浅表型IH和混合型IH的浅表病灶是外用咪喹莫特治疗的适应证,治疗后局部皮肤反应轻微,不引起局部组织萎缩和身体发育迟滞,对腔穴部位及皮肤皱褶处应避免使用,用药方式简单便捷,可作为IH浅表病灶的安全有效的治疗方法.     

Topical imiquimod therapy for lentigo maligna

Lentigo maligna (LM) presents a challenge for complete surgical excision. Imiquimod is a topical immune-response modifier that acts on the immune system. We report our experience using imiquimod 5% cream as a surgical alternative for treatment of LM. Consecutive patients between December 2004 and February 2006 with LM were treated with topical imiquimod. Data on patient and lesion characteristics, side effects of therapy, posttreatment biopsy results, and follow-up was collected. Seven patients were treated with imiquimod 5 nights/wk for 12.4 weeks. Complete histologic and clinical resolution was seen in 86% (6 of 7 patients), at 19.1 months follow-up. Side effects included erythema (86%) and crusting (71%), resulting in dose alteration in 71% of patients. Topical imiquimod therapy demonstrates a high response rate for treatment of LM, with tolerable side effects. Further investigation into its efficacy in the treatment of LM in controlled clinical trials is warranted.     

Therapeutic Response of a Brother and Sister with Xeroderma Pigmentosum to Imiquimod 5% Cream

BACKGROUND: Xeroderma pigmentosum (XP) is an autosomal recessive disease marked by solar sensitivity, photophobia, early onset of freckling, and solar-induced cutaneous neoplastic changes. These patients can often develop hundreds of cutaneous tumors, making surgical therapy difficult. Imiquimod 5% cream has been shown to have activity in treating various cutaneous malignancies. OBJECTIVE: To examine the effectiveness and tolerability of imiquimod 5% cream in treating facial basal cell carcinomas (BCCs) in a brother and sister with XP. These patients were developing skin cancers faster than could be managed surgically and had failed 6 months of chemoprophylaxis with isotretinoin. METHODS: Imiquimod 5% cream was applied to the faces of these two patients as frequently as tolerated, with the goal of gaining control over the many clinically evident BCCs present on the faces of these siblings. We also examined whether we could reduce the rate of new neoplasm development. RESULTS: The brother in our study tolerated imiquimod 5% cream twice a day every day with minimal inflammatory response. He had clinical resolution of many of the BCCs present within the treatment area as well as shrinking of many of the remaining lesions. He has continued to produce new tumors at a substantially reduced rate relative to his pretreatment baseline. The sister in our study exhibited a severe inflammatory response to imiquimod 5% cream, with facial swelling and erosion of the treated area with application as infrequent as three times a week. In spite of the vastly different inflammatory response, her cutaneous tumors responded favorably to therapy as well. CONCLUSION: Imiquimod 5% cream was effective in treating facial BCCs in these siblings with XP. As well, we have noted a significant reduction in the development of new tumors within the imiquimod-treated area. The inflammatory response to this medicine was at opposite extremes among these two siblings. However, this did not appear to alter the therapeutic benefit of this therapy.     

Topical Imiquimod as an Adjuvant to Laser Removal of Mature Tattoos in an Animal Model

BACKGROUND: Lasers are a commonly employed method of tattoo removal; however, numerous treatments are often needed and laser treatment may fail to eliminate the tattoo completely. It has been shown in animal studies that topical application of imiquimod cream, alone, fades tattoos. It is suspected that the combination of both imiquimod and laser treatment will result in enhanced tattoo pigment clearance. OBJECTIVE: The objective was to evaluate the efficacy of topical imiquimod cream as an adjuvant to laser removal of mature tattoos. METHODS: Fourteen albino guinea pigs were tattooed with black ink, then randomly assigned into two groups: one underwent sequential laser treatments with a Q-switched alexandrite laser in conjunction with triweekly applications of 5% imiquimod cream, while the other group underwent laser therapy alone. Subjects were evaluated with clinical photographs and skin biopsies after six laser treatment sessions. RESULTS: The combination laser and imiquimod treated group was clinically and histologically rated as having less pigment than the tattoos that were treated with laser alone (p=.012 and p=.047, respectively). Adjuvant imiquimod treatment had greater inflammation (p=.002) and fibrosis (p=.002) on posttreatment skin biopsies. CONCLUSION: Imiquimod appears to be a useful adjuvant to experimental laser tattoo removal in guinea pigs.     

A Pilot Study to Evaluate the Treatment of Basal Cell Carcinoma with 5-Fluorouracil Using Phosphatidyl Choline as a Transepidermal Carrier

BACKGROUND: In certain situations, successful topical therapy of basal cell carcinoma (BCC) without the inconvenience, risk, and expense of surgery would be of great value to patients. Placing 5-fluorouracil (FU) in an appropriate carrier may solve these problems. Phosphatidyl choline (PC) penetrates effectively throughout the epidermis of shaved rabbits and may be able to carry small water-soluble molecules such as nucleotides across lipid barriers when applied topically. OBJECTIVE: We propose that employing PC as a vehicle will facilitate the penetration of 5-FU and increase efficacy as compared to petrolatum-based 5-FU cream. METHODS: This pilot study is a double-blinded and randomized therapeutic trial. Thirteen patients with 17 biopsy-proven, moderate thickness BCCs were randomized to receive either cream A (5% 5-FU in a PC vehicle) or cream B (Efudex(R): 5% 5-FU in a petrolatum base). Patients applied cream A or cream B twice a day for 4 weeks. The patients underwent an excisional biopsy of the treated BCC site at week 16. RESULTS: There was a 90% cure rate (9/10) in those lesions treated with 5% 5-FU in PC cream and a 57% cure rate (4/7) in those treated with 5% 5-FU in a petrolatum-based cream. CONCLUSION: Although the study was unable to detect any statistically significant differences in outcome between the study groups, this small pilot study shows preliminary findings which may indicate an increase in the short-term eradication of BCC using a PC-based vehicle as compared to conventional petrolatum-based formulations.     

Treatment of Lentigo Maligna with Imiquimod before Staged Excision

BACKGROUND Imiquimod 5% cream has demonstrated effectiveness in the treatment of lentigo maligna (LM) in several small studies. None of the studies to date have included posttreatment surgical removal to confirm negative histologic margins.
OBJECTIVE The aim of this retrospective analysis was to assess the efficacy of topical imiquimod in LM by circumferentially examining vertically oriented sections from a geometrically designed "picture frame" margin as well as bread-loafed sections of the central portion after staged excisions of imiquimod-treated lesions of LM.
METHODS Forty patients with biopsy-confirmed LM were treated five times a week for 3 months with 5% imiquimod cream before staged excision. Tazarotene 0.1% gel was added when no clinical signs of erythema developed with imiquimod alone after 1 month (10 patients). After the course of topical therapy, patients were assessed for clinical and complete histologic clearance after staged excision.
RESULTS A total of 33 of 40 patients had a complete clinical response as determined by the absence of remaining clinical lesion on physical examination. Upon histologic review, 30 of 40 patients had no evidence of LM whereas 10 of 40 harbored residual disease. One patient was found to have histologic evidence of invasion after completing the topical protocol. After a mean follow-up of 18 months (range, 12–34 months) and after complete surgical excision of the treatment site, none of the imiquimod-treated patients had evidence of recurrence.
CONCLUSIONS Imiquimod appears to be an effective adjunctive treatment for LM but does not qualify as a replacement therapy for surgery.     

Squamous Cell Carcinoma in Situ (Bowen''s Disease) in Renal Transplant Patients Treated with 5% Imiquimod and 5% 5-Fluorouracil Therapy

BACKGROUND: Depending upon the patient's age at transplant, skin type, sun exposure, and the need for immunosuppressive therapy to prevent rejection, there is escalation in the development of cutaneous malignancies in organ transplant patients a number of years after transplantation. Thus, with the expansion in these procedures over the past decades, and the ever-lengthening survival of these patients, we are seeing an increase in cutaneous malignancies in this patient population. OBJECTIVE: To determine if combined therapy with 5% 5-fluorouracil and 5% imiquimod may be useful in the treatment of squamous cell carcinoma in situ. METHODS: We present five renal transplant patients, all more than 10 years posttransplantation, three with insulin-dependent diabetes, who developed multiple areas of squamous cell carcinoma (SCC) in situ. All these patients were on chronic immunosuppressive chemotherapy to prevent rejection, but were otherwise doing well. All the patients had biopsy-proven SCC in situ on their lower extremities that even in normal patients may be a challenge to treat. RESULTS: We treated these five patients with a combination of a local immune therapy, imiquimod cream, and a topical chemotherapeutic agent, 5% 5-fluorouracil (5-FU), with clearing of the areas of SCC in situ. CONCLUSION: Although immunotherapy must be used with caution in organ transplant patients to avoid graft rejection, topical imiquimod is a local immune modulator that potentiates local innate and possible adaptive immunity without measurable effects on systemic immunity. In addition, there is evidence that cytokines induced by imiquimod may improve the therapeutic efficacy of topical 5% 5-FU in the treatment of SCC in situ.     

The Use of Noninvasive Optical Coherence Tomography to Monitor the Treatment Progress of Vismodegib and Imiquimod 5% Cream in a Transplant Patient with Advanced Basal Cell Carcinoma of the Nose

Immunosuppressed transplant recipients have increased risk for the development of basal cell carcinoma skin cancers. While oral vismodegib therapy has been successful in treating locally advanced basal cell tumors, few studies document its use and efficacy in organ transplant patients. In this immunocompromised population, topical imiquimod 5% cream has been shown to be an effective and well-tolerated option for superficial and nodular basal cell carcinomas. To the authors’ knowledge, no data documents the use of optical coherence tomography, a noninvasive imaging technique, to monitor progress of such combined therapies on in vivo skin. The authors report the successful treatment of an extensive basal cell carcinoma on the nose of an immunosuppressed 54-year-old Caucasian man with a history of kidney and pancreas transplantations. By combining continuous noninvasive lesion monitoring with vismodegib 150mg/d therapy and adjuvant imiquimod 5% topical cream, the patient showed complete disease clearance on clinical, optical coherence tomography, and histological evaluation. This report supports the feasibility and efficacy of nonsurgical treatment of basal cell lesions in complicated transplant patients and the need for individualized treatment plans. A noninvasive follow-up tool, especially during nonsurgical therapy, is of critical value to ensure the best possible treatment outcome for the patient.Basal cell carcinoma (BCC) is the most common malignancy in individuals of mixed European descent, and accounts for approximately 80 percent of all skin malignancies.1-3 The risk for developing BCC is greatly increased in organ transplant recipients who use a combination of immunosuppressive drug therapies for prolonged periods of time.4-6 BCC is the second most frequent skin cancer assoiated with immunosuppression and more commonly metastasizes in this population than patients who have human immunodeficiency virus/acquired immune deficiency syndrome (HIV/AIDS) or iatrogenic images of tissue micro-architecture down to a depth of immunodeficiency.4,6,7 The management of extensive BCC in immunosuppressed organ transplant recipients can be a challenge for dermatologists.The current gold standard of diagnosis and management of extensive and infiltrative BCC is clinical and histopathological evaluation followed by surgical excision.3. Such invasive procedures often lead to poor cosmetic outcomes and/or functional impairment8 and there has been increased focus on alternative nonsurgical diagnostic, follow-up and treatment modalities for these patients.Optical coherence tomography (OCT), a noninvasive maging technique, allows for real-time detection and assessment of skin lesions. OCT uses near-infrared light to generate high-resolution black and white cross-sectional 2mm.9-12 These images depict cellular components in the same plane as traditional histological cuts, and studies have established that they are sufficiently detailed for identification of morphological criteria for BCC and other nonmelanoma skin cancers (NMSC).8,9,11,13,15 The OCT diagnostic sensitivity and specificity for NMSC varies by study, but ranges from 79 to 94 percent and 85 to 96 percent, respectively, whereas the clinical diagnostic sensitivity and specificity for NMSC ranges from 56 to 90 percent and 75 to 90 percent, respectively.12,14,15 Regardless of the reported sensitivities and specificities, these studies have all shown OCT to improve diagnostic accuracy. More recently, the diagnostic value of OCT, specifically for BCC, was demonstrated in a population of clinically challenging lesions.15 OCT improved diagnostic certainty by a factor of four over clinical examination alone, and improved diagnostic accuracy by 50 percent.15 With OCT imaging, 48 percent more BCCs were detected than by clinical examination alone, and sensitivity in this population increased from 62.9 to 92.9 percent.15 As such, OCT offers a powerful diagnostic tool for NMSC and can be used to monitor lesion treatment progress.12Nonsurgical treatment options for locally advanced or metastatic BCCs include vismodegib (Erivedge, Genentech-Curis), the first and only available oral hedgehog pathway inhibitor drug.2,16-18 While this novel treatment is efficacious in treating metastasized, recurrent, and inoperable BCCs, adverse side effects such as nausea, vomiting, muscle cramps, decreased appetite, weight loss, and alopecia can preclude long-term use.16,18 Furthermore, efficacy of vismodegib treatment has not been determined in organ transplant recipients. More established topical field treatments, such as imiquimod 5% cream (Aldara, 3M Pharmaceuticals), have been shown to be effective treatments for superficial and nodular BCCs in the immunosuppressed population.20Herein, the authors present an immunocompromised transplant recipient monitored noninvasively with OCT imaging to assess tissue morphology throughout nonsurgical combination therapy with oral vismodegib and imiquimod cream. To their knowledge, there is limited literature on the use of vismodegib in transplant patients, and this is the first reported case of its combination with imiquimod cream for advanced BCC in an immunosuppressed transplant patient that shows complete lesion clearance.     

Successful Treatment of Earlobe Keloids with Imiquimod after Tangential Shave Excision

BACKGROUND: The treatment of earlobe keloids has historically been suboptimal; characterized by discomfort, poor response, and high rates of recurrence. Keloids are characterized by increased fibroblast activity in the setting of an altered cytokine profile. OBJECTIVE: To investigate whether topical imiquimod 5% cream applied postoperatively after tangential excision can prevent recurrence of earlobe keloids. METHODS AND MATERIALS: Four patients with a total of eight large pedunculated earlobe keloids (five of which were recurrent lesions) were treated with debulking by tangential shave excision followed by daily application of imiquimod 5% cream for 6 weeks. RESULTS: At 6 and 12 months post-treatment there was an excellent cosmetic result and no evidence of recurrence in any of the lesions. Patients with keloids that were itchy and painful were completely asymptomatic at the conclusion of the study. CONCLUSION: In this pilot study, imiquimod 5% cream following tangential shave excision was efficacious for the treatment of earlobe keloids. Further study is warranted to confirm the utility of imiquimod 5% cream in the treatment of earlobe keloids, as illustrated herein.     

复方倍他米松联合5%咪喹莫特治疗瘢痕疙瘩的临床观察

目的：观察复方倍他米松注射液皮损内注射联合5%咪喹莫特外涂治疗瘢痕疙瘩的临床疗效和安全性。方法：将80名瘢痕疙瘩患者分为两组,治疗组给予复方倍他米松注射液皮损内注射,每2周1次,同时外涂5%咪喹莫特隔日1次,总疗程为8周;对照组单纯给予复方倍他米松注射液皮损内注射。结果：1个月随访时,治疗组及对照组改善率分别为67.57%及60.47%,无显著差异;3个月随访时,治疗组改善率为80.56%,显著高于对照组的65.85%。治疗期间无失访患者,不良反应为注射部位轻中度疼痛感、不适感,偶见轻度萎缩、轻度毛细血管扩张及多毛。结论：复方倍他米松注射液皮损内注射联合5%咪喹莫特外涂治疗瘢痕疙瘩安全有效、复发率低,患者依从性好。     

Bowen's Disease (Squamous Cell Carcinoma In Situ) in Immunosuppressed Patients Treated with Imiquimod 5% Cream and a COX Inhibitor, Sulindac: Potential Applications for This Combination of Immunotherapy

BACKGROUND: Patients with chronic lymphocytic leukemia (CLL) often have a protracted course. However, all these patients are immunosuppressed and may have a high incidence of cutaneous malignancies. OBJECTIVE: To determine if combination therapy using topical imiquimod cream 5% and the oral cyclooxygenase (COX) inhibitor are useful in the therapy of squamous cell carcinoma in situ (SCC in situ)/Bowen's disease in patients with long-standing CLL. METHODS: Five CLL patients with head and neck cutaneous SCC in situ, which met criteria for Bowen's disease, were treated with topical 5% topical imiquimod cream and an oral COX inhibitor, sulindac 200 mg twice a day. RESULTS: All patients showed clinical resolution and histologic clearing of the tumors after 16 weeks of therapy. CONCLUSION: The local immune modulator, 5% imiquimod, in combination with a COX inhibitor, with its many potential antitumor effects may stimulate the innate and possibly the adaptive immune responses to clear these malignancies.     

Combined imiquimod and acitretin for non-surgical treatment of basal cell carcinoma

We report the successful outcome of treatment of a basal cell carcinoma (BCC) with topical imiquimod and systemic acitretin in a 48-year-old woman. We think that this treatment is a possible option for management of these non-life-threatening tumours. Experimental evidence suggests that combination treatment with retinoids increase the effects of imiquimod and would therefore seem to be possible when treating superficial tumours in areas where the cosmetic outcome is particularly important.     

Imiquimod to Treat Different Cancers of the Epidermis

BACKGROUND: Topical immunomodulatory therapy with imiquimod has been recently used for the treatment of actinic keratoses, intraepithelial carcinoma, and small basal cell carcinoma (BCC) besides the licensed indication of extragenital warts (condyloma). METHODS: We treated several patients with particular epidermal neoplasias such as squamous cell cancer (SCC) and basal cell cancer of sclerodermiform type three times per week for 4 to 12 weeks. RESULTS: We report several novel aspects of the treatment of epidermal cancers with self-applied, nonpainful, immunomodulatory therapy. First, we treated-for the first time-two immunosuppressed renal transplant patients for invasive SCC with imiquimod. Interestingly, systemic immunosuppression did not adversely affect the response to therapy. Second, one patient with the high-risk and aggressive growth pattern of basal cell cancer (sclerodermiform histology) was cured from his disease at a particular location in the face, suggesting sufficient penetration despite scarring. No recurrence was detected in another patient who suffered from 29 BCCs until almost 2-years follow-up. Third, the treatment of actinic keratoses in the face is substantially shorter (in the order of 4 to 6 weeks) as opposed to other skin cancers. Immunomodulatory treatment with imiquimod led to the demarcation of in situ actinic keratosis lesions that could not be identified using the dermatologist's experience, probably because of the existence of exclusive alterations on the molecular level. CONCLUSION: Several novel aspects of immunomodulatory treatment with imiquimod and new indications such as selected cases of sclerodermiform BCC and SCC have been described. The texture of the skin at various different body locations may explain the varying sensitivities to imiquimod when facial skin is compared with skin on the extremities.     

Imiquimod 5% Cream for Keloid Management

BACKGROUND: Keloid treatment represents a therapeutic challenge. New adjuvant therapy is needed to reduce the high recurrence rate (50%) of excised keloids. OBJECTIVE: To describe the method for using imiquimod 5% cream in the prevention of keloid recurrence after surgery. METHODS: This is a review of the scientific rationale and clinical experience of using imiquimod 5% cream for keloid management. CONCLUSION: Topical application of imiquimod 5% cream after surgery reduces keloid recurrences.