Imiquimod 5% cream as adjunctive therapy for primary, solitary, nodular nasal basal cell carcinomas before Mohs micrographic surgery: a randomized, double blind, vehicle-controlled study.
BACKGROUND
Imiquimod 5% cream is currently approved for treatment of nonfacial, superficial basal cell carcinomas (BCCs). Topical imiquimod might be a reasonable candidate for adjunctive therapy of nodular, nasal BCCs before Mohs surgery.


OBJECTIVE
To observe the effectiveness of imiquimod 5% cream in reducing the number of Mohs stages, defect size, cost of Mohs surgery, and reconstruction.


METHODS
Patients applied the study medication nightly for 6 weeks with occlusion followed by a 4-week rest period before Mohs surgery was performed.


RESULTS
No differences were demonstrated in the number of Mohs stages, defect sizes, or costs between the two groups, possibly because of our small sample size. Only five of 12 patients (42%) in the treatment group were found histologically clear of tumor (complete responders).


CONCLUSIONS
Imiquimod 5% cream was not helpful as an adjunctive treatment of nodular, nasal BCCs before Mohs surgery, but a larger study might show a benefit. Clearance of nodular, nasal BCCs treated with imiquimod prior to Mohs surgery was less than described in previous studies. Nasal BCCs may be more resistant to imiquimod treatment. Local inflammatory reactions limit imiquimod's usefulness in this setting. Histologic assessment of nasal BCCs treated with imiquimod is recommended.
Butler
David F
DF
Department of Dermatology, Scott & White Memorial Hospital and Clinic, Texas A&M University College of Medicine, Temple, Texas, USA. dfbutler@swmail.sw.org
Parekh
Palak K
PK
Lenis
Armando
A
D000287:Administration, Topical; D000368:Aged; D000369:Aged, 80 and over; D000634:Aminoquinolines / Q000008:administration & dosage* / Q000009:adverse effects; D000970:Antineoplastic Agents / Q000008:administration & dosage* / Q000009:adverse effects; D002280:Basal Cell Carcinoma / Q000628:therapy*; D003131:Combined Modality Therapy; D004311:Double-Blind Method; D005260:Female; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery; D009669:Nose Neoplasms / Q000628:therapy*; D009824:Ointments
D000634:Aminoquinolines; D000970:Antineoplastic Agents; D009824:Ointments; D000077271:Imiquimod