Confirmation of histological clearance of superficial basal cell carcinoma with multiple serial sectioning and Mohs' micrographic surgery following treatment with imiquimod 5% cream.
BACKGROUND
Although the effectiveness of daily dosing regimens of 5% imiquimod cream for the treatment of superficial basal cell carcinomas (sBCC) has been documented by recent studies, concerns about long-term outcome remain. The majority of efficacy data is based on clinical clearance and limited histological examination which may not identify tumour presence at the periphery.


OBJECTIVE
To assess the efficacy of 5% imiquimod cream for sBCC using detailed histological assessment 1 year after completion of treatment.


METHODS
Nine individuals with biopsy-proven sBCC treated with 5% imiquimod cream 1 year previously and who remained clinically clear were recruited. Paraffin-embedded excision specimens from the original tumour site were extensively examined by a dermatopathologist. Examination and analysis of frozen sections of the original tumour perimeter using Mohs' micrographic surgery (MMS) were then performed.


RESULTS
Eight of nine individuals, 89% (95% CI 56% to 97%) were histologically clear of sBCC at 52 weeks. One individual had a single focus of sBCC at one lateral margin.


CONCLUSIONS
The results show agreement between the clinical and histological assessment of tumour clearance. However, the persistence of disease in one patient, although limited, indicates the need for cautious long-term follow-up studies on the use of 5% imiquimod cream for sBCC.
Department of Dermatology, Ninewells Hospital and Medical School, Dundee, UK.
Francesca I
FI
Ezughah
Andrew G
AG
Affleck
Alan
A
Evans
Sally H
SH
Ibbotson
Colin J
CJ
Fleming
D000279:Administration, Cutaneous; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000627:therapeutic use*; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D002280:Basal Cell Carcinoma / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D016591:Histocytological Preparation Techniques; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009364:Neoplasm Recurrence, Local / Q000473:pathology*; D012867:Skin / Q000473:pathology*; D012878:Skin Neoplasms / Q000188:drug therapy* / Q000473:pathology / Q000601:surgery; D016896:Treatment Outcome
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod