the management of basal cell carcinoma
Topical therapy
Treatment is especially useful for low-risk, extrafacial BCC but it cannot be expected to eradicate invasive BCC.
Topical Imiquimod
Imiquimod is an immune response modifier (IRM). It has been successfully used for the treatment of cutaneous neoplasias as well as viral skin diseases and acts as an antitumour agent principally by both production alpha interferon and other cytokines and induction of apoptosis.
The use of imiquimod 5% cream for the treatment of superficial (sBCC) and nodular BCC (nBCC) was recently investigated comparing low frequency dosing with and without occlusion for 6 weeks. In patients with superficial BCC the highest complete clearance rates ranged between 87% with occlusion (20 of 23 patients) and 76% without occlusion (19 of 25 patients). Several studies have shown a clearance rate (judged at 3 months with histology) of 87.9% with one application/day for 6 weeks and of 80.8% (with one application /day/5 days/w for 6 weeks)in sBCC without occlusion. If applied 5 times per week for 6 weeks (pooled analysis of two double-blind vehicle controlled clinical trials) a histological clearance was noted in 82% (152/185) of patients. Clearance was assessed by excisional histology at the completion of treatment. Interim results from a long-term open-label uncontrolled study indicate an estimated sustained clearance of 92% at 12 months. The recommendation of prescription of imiquimod for the treatment of sBCC is actually once/day, 5 times/week for 6 weeks.
In the nodular BCC group (7 days per week treatment, 12 weeks therapy) the percentage of complete responders was only 76% (16 of 21) and 71% (7 days per week, 6 weeks) . Therefore imiquimod is not actually recommended for the treatment of nodular BCC.
A successful treatment of multiple BCCs with topical imiquimod in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) was also reported.
Topical therapy
Treatment is especially useful for low-risk, extrafacial BCC but it cannot be expected to eradicate invasive BCC.
Topical Imiquimod
Imiquimod is an immune response modifier (IRM). It has been successfully used for the treatment of cutaneous neoplasias as well as viral skin diseases and acts as an antitumour agent principally by both production alpha interferon and other cytokines and induction of apoptosis.
The use of imiquimod 5% cream for the treatment of superficial (sBCC) and nodular BCC (nBCC) was recently investigated comparing low frequency dosing with and without occlusion for 6 weeks. In patients with superficial BCC the highest complete clearance rates ranged between 87% with occlusion (20 of 23 patients) and 76% without occlusion (19 of 25 patients). Several studies have shown a clearance rate (judged at 3 months with histology) of 87.9% with one application/day for 6 weeks and of 80.8% (with one application /day/5 days/w for 6 weeks)in sBCC without occlusion. If applied 5 times per week for 6 weeks (pooled analysis of two double-blind vehicle controlled clinical trials) a histological clearance was noted in 82% (152/185) of patients. Clearance was assessed by excisional histology at the completion of treatment. Interim results from a long-term open-label uncontrolled study indicate an estimated sustained clearance of 92% at 12 months. The recommendation of prescription of imiquimod for the treatment of sBCC is actually once/day, 5 times/week for 6 weeks.
In the nodular BCC group (7 days per week treatment, 12 weeks therapy) the percentage of complete responders was only 76% (16 of 21) and 71% (7 days per week, 6 weeks) . Therefore imiquimod is not actually recommended for the treatment of nodular BCC.
A successful treatment of multiple BCCs with topical imiquimod in nevoid basal cell carcinoma syndrome (Gorlin-Goltz syndrome) was also reported.
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