Superficial basal cell carcinoma treated with imiquimod 5% topical cream for a 4-week period: a case series

Basal cell carcinoma (BCC) is a malignant cutaneous neoplasm with a tendency to spread locally and with several clinical and histological subsets. We studied 82 patients with a clinical diagnosis of superficial BCC on different anatomical locations, to whom imiquimod 5% cream was administered on a low-frequency regime (three times a week for 4 weeks), and who were followed up 2 years after completion of treatment. Clinical clearance rate at 1 and 2 years were 89% and 85%, respectively. We conclude that imiquimod seems to be an appropriate therapeutic alternative for the treatment of superficial BCC in patients with associated comorbidities.

Conflicts of interest

None declared     

Efficacy of imiquimod for the expression of Bcl-2, Ki67, p53 and basal cell carcinoma apoptosis

BACKGROUND: Imiquimod is a modifier of the immune response that has been proven to be an effective treatment for basal cell carcinoma (BCC). However, its mechanism of action is still unknown. OBJECTIVES: To determine whether imiquimod modifies the expression of proteins such as Bcl-2, Ki67, p53 and the BCC apoptotic index. PATIENTS AND METHODS: Thirty caucasian patients with primary BCCs larger than 8 mm in diameter were included in a double-blind randomized clinical and immunohistochemical study which was designed in a reference university hospital. The 30 BCCs were randomized in two treatment arms between September 2001 and February 2002. Twenty-four BCCs were treated with imiquimod 5% cream and six BCCs with Aldara (3M Pharmaceuticals) excipient. Histological samples were obtained before treatment and on days 8 and 15 during the course of treatment. The BCC expression of Bcl-2, Ki67 and p53 was determined in paraffin samples and the apoptotic index of the BCC was studied using the TUNEL technique (terminal deoxynucleotidyl transferase-mediated deoxyuridine triphosphate biotin nick end labelling) in frozen samples. All variables were evaluated quantitatively in fields with a magnification x 400. RESULTS: The BCCs treated with imiquimod showed a decrease in the expression of Bcl-2 (88.7% before treatment, 61.4% day 15, P = 0.01) and an increase in the apoptotic index (0.53% before treatment, 1.66% day 15, P = 0.002), which were not observed in the BCCs treated with the excipient. Ki67 and p53 did not show significant changes in any group. CONCLUSIONS: Imiquimod reduces the expression of Bcl-2 in the BCC cells and increases the BCC apoptotic index.     

Multiple facial basal cell carcinomas in xeroderma pigmentosum treated with topical imiquimod 5% cream

Xeroderma pigmentosum (XP) is an autosomal recessive disease characterized by solar sensitivity, photophobia, early onset of freckling, and solar‐induced cutaneous neoplastic changes. Management of patients with XP is a therapeutic challenge as they usually develop multiple cutaneous malignancies, making surgical therapy difficult, and continue to form skin malignancies at a high rate. We describe a 30‐year‐old Chinese man with XP who had been previously treated with excision and dermatoplasty. Upon recurrence of multiple superficial, ulcerative, and pigmented lesions, imiquimod 5% cream was recommended for 4 months. His multiple facial lesions demonstrated an excellent response to topical imiquimod 5% cream with minor side effects. This favorable response indicates that topical application of imiquimod 5% cream is an effective means of treating multiple basal cell carcinomas in XP.     

Vitiligo-like depigmentation induced by imiquimod treatment of superficial basal cell carcinoma

A 61-year-old man was treated with imiquimod 5% cream for superficial basal cell carcinoma, five times per week for 13 weeks. This resulted in vitiligo-like depigmentation and poliosis in the area of treatment. This rare side-effect has been noted in previous case reports of imiquimod treatment for both genital warts and superficial basal cell carcinoma. This highlights the importance of such a side-effect being discussed with the patient who is to be treated with imiquimod, particularly in cosmetically sensitive areas.     

Excellent response of basal cell carcinomas and pigmentary changes in xeroderma pigmentosum to imiquimod 5% cream

Xeroderma pigmentosum (XP) is an autosomal recessive disease in which patients have a 1000-fold increased risk of developing cutaneous neoplasms. Management of patients with XP is a difficult therapeutic challenge as they usually present with many cutaneous malignancies and continue to form skin tumours at a high rate. We describe a 19-year-old woman with XP who had been previously treated with many different therapeutic approaches. She had an excellent clinical response of her multiple small pigmented basal cell carcinomas and pigmentary changes using imiquimod 5% cream with only minor side-effects.     

Imiquimod 5% cream for the treatment of superficial and nodular basal cell carcinoma: randomized studies comparing low-frequency dosing with and without occlusion

BACKGROUND: Imiquimod 5% cream has been investigated for non-surgical treatment of superficial and nodular basal cell carcinoma (BCC) tumours. OBJECTIVES: Two studies were conducted to examine the effect of occlusion at low dosing frequencies on the safety and efficacy of topical imiquimod 5% cream for the treatment of superficial and nodular BCC. PATIENTS AND METHODS: Both open-label studies were conducted in Europe. Patients diagnosed with BCC were enrolled into either the superficial (93 patients) or nodular (90 patients) study, depending on the histological confirmation of the patient's tumour subtype. Patients were randomized to one of four groups to apply imiquimod 5% cream 2 or 3 days per week either with or without occlusion. Six weeks following a 6-week treatment period, the entire target tumour area was excised and histologically examined for evidence of residual tumour. RESULTS: In both studies, the highest histologically complete response rate was seen in the 3 days per week with occlusion groups, with complete response rates of 87% and 65% for the superficial and nodular studies, respectively. Occlusion did not have a statistically significant effect on response rate at either dosing frequency. Response rates for superficial and nodular BCC tumours treated 3 days per week without occlusion were 76% and 50%, respectively. CONCLUSIONS: In the superficial study, the complete response rate of 87% in the 3 days per week with occlusion group was similar to that of daily and 5 days per week dosing without occlusion in a previous 12-week study and one study of daily dosing without occlusion for 6 weeks. All treatment groups had acceptable safety profiles in both studies. Occlusion did not have a statistically significant effect on efficacy for either superficial or nodular BCC tumours.     

痣样基底细胞癌综合征一例

痣样基底细胞癌综合征是一种罕见的常染色体显性遗传病,以泛发性皮肤基底细胞癌和多器官发育异常为主要临床特征。本文报告1例痣样基底细胞癌综合征患者,并结合相关文献对该病的发病率、发病机制、诊断标准、治疗方法等进行讨论。     

色素性基底细胞癌一例

患者女,67岁.主因左耳后皮疹20年,溃烂2年余就诊.患者自述20年前左耳后长出一绿豆大小皮肤色丘疹,无自觉症状,数年后丘疹略增大,表面变粗糙,当地医院诊断刺瘊,自行数次用头发捆勒祛除之,未见效,皮疹增长缓慢无不适感.近5年常令其子用烟头烫,2年来丘疹反复糜烂、渗液、结痂,基底渐增大,色变黑,皮疹增大至鸽卵大小,中心溃烂不愈,无痛、痒感.     

Incipient retinal vein occlusion following immunotherapy of periorbital basal cell carcinoma

We report a case of retinal vein occlusion in a 54-year-old woman following treatment with topical imiquimod for a superficial basal cell carcinoma of the temple. Signs and symptoms resolved rapidly upon ceasing treatment. Although they are uncommon, it is important to recognise and promptly manage ophthalmic complications related to treatment with imiquimod in order to prevent serious sequelae such as macular oedema and neovascularization.     

Treatment of basal cell carcinoma

Basal cell carcinoma is the most common tumor in Central Europe, the U.S. and Australia. The increasing incidence of basal cell carcinoma presents the health care system, especially dermatology, with great challenges. In recent years new options for treating basal cell carcinoma have become available, enriching our therapeutic options. We review the current status of each of these treatment approaches.     

息肉样基底细胞癌

报告1例息肉样基底细胞癌.患者女,77岁.右腋下赘生物25年,变红伴疼痛1年.皮肤科检查:右侧腋下可见蚕豆大暗红色息肉样半球形赘生物.皮损组织病理检查:表皮增生肥厚,部分区域向下增生,形成条索状及块状肿瘤细胞团块,肿瘤细胞团块由基底样细胞组成,细胞核大深染,可见核分裂象,部分边缘呈栅栏状排列,可见收缩间隙;真皮内可见间...     

Dermoscopy‐guided surgery in basal cell carcinoma

Background In basal cell carcinoma (BCC), excision margins between 3 and 10 mm, according to site, size, borders, previous treatment and histology, can allow for radical excision in at least 95% of cases. Objective The objective was to ascertain whether dermoscopy can detect more accurately the lateral borders in BCCs than clinical examination alone, and allow us to obtain radical excision in more than 95% of cases with only 2‐mm excision margins. Methods A prospective study was performed of 200 consecutive BCCs of the head and neck removed with 2‐mm dermoscopically detected excision margins. Morpheaform BCC, deeply recurrent BCC, BCC in Gorlin‐Goltz syndrome, BCC located in sites not accessible through dermoscopy and superficial multifocal BCC were excluded. All cases of excised BCC were submitted to a uniform method of histological examination of the whole specimen with serial parallel sections at 2‐mm intervals. Results In only three cases did surgical excision with 2‐mm margins prove to be inadequate; in the remaining 197 cases, the excision margins were tumour‐free. The comparison of clinical and dermoscopic extension measurement showed concordance in 131 cases (65.5%). In 69 cases (34.5%), dermoscopic evaluation showed a larger peripheral extension. Conclusions These results indicate that 2‐mm dermoscopically detected excision margins can achieve histologically confirmed complete excisions in 98.5% of cases.     

反射式共聚焦显微镜在多发性基底细胞癌诊断及治疗随访中的应用

目的：观察多发性基底细胞癌反射式共聚焦显微镜（RCM）影像特征,探讨RCM在多发性基底细胞癌诊断及治疗随访中的价值。方法：对在我科就诊的6例疑似多发性基底细胞癌患者64处皮损行RCM检查,62处皮损诊断为基底细胞癌,其中39处行手术切除并行组织病理检查,23处皮损外涂5%咪喹莫特乳膏治疗,治疗后RCM随访。对基底细胞癌的RCM特征进行归纳总结。结果：手术切除行组织病理检查的39处皮损均符合基底细胞癌,与RCM符合率100%,手术切除后3个月、6个月RCM随访,均未发现基底细胞癌RCM特征。外用5%咪喹莫特乳膏的 23处皮损,治疗后3个月、6个月、12个月,分别有12处、8处、4处仍有基底细胞癌RCM特征。 RCM诊断为基底细胞癌的62处皮损特征：异形角质形成细胞96.8%,与表皮相连90.3%,肿瘤细胞巢96.8%,肿瘤巢周围裂隙样暗区54.8%,肿瘤巢周边细胞栅栏状排列51.6%,肿瘤巢内高折光树枝状结构77.4%,肿瘤间质内血管增生扩张充血95.2%,肿瘤巢内及周围高折光颗粒77.4%。结论：基底细胞癌在RCM下有特征性表现,RCM可作为多发性基底细胞癌诊断及治疗随访的有效手段。     

硬斑病样基底细胞癌

报告1例硬斑病样基底细胞癌。患者女,38岁。左眉间淡黄色丘疹3年,增大伴糜烂、结痂2年。皮肤科检查：眉间偏左有一基底约3cm×3.5cm大、略隆起的局限性浸润性蜡样硬斑块,表面有一约1.2cm×1.5cm、高低不平的浅溃疡。组织病理诊断：硬斑病样基底细胞癌。