title: Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study.
abstract: BACKGROUND
  Imiquimod 5% cream can reduce or clear superficial and small nodular basal cell carcinoma (BCC). It could be used as a pretreatment of Mohs micrographic surgery (MMS) to decrease defect size.
  
  
  OBJECTIVE
  To study if a pretreatment with imiquimod 5% cream decreases defect size after MMS. In addition, to study the effect on the number of Mohs stages and reconstruction time.
  
  
  METHODS
  Seventy patients aged >18 years with a primary nodular BCC in the face were included. The imiquimod group used imiquimod 5% cream for 4 weeks, before MMS. The control group was treated with MMS only. Tumour and defect sizes were measured. We noted the number of Mohs stages, reconstruction time and side-effects.
  
  
  RESULTS
  The median percentage increase in area from tumour size at baseline to the post-MMS defect for the imiquimod group was significantly less compared with the control group, 50% vs. 147% (P < 0·001). A tendency towards fewer Mohs stages in the imiquimod group was observed and the reconstruction time was significantly shorter in this group (P = 0·01).
  
  
  CONCLUSIONS
  Imiquimod 5% cream as pretreatment of MMS significantly reduced the tumour size in primary nodular BCC and reduced the surgical defect size. Further research is necessary to investigate cost-effectiveness.
authors.affiliation: Department of Dermatology, Catharina Hospital Eindhoven, 5623 EJ Eindhoven, the Netherlands. simone.vd.geer@cze.nl
authors.forename: S
authors.initials: S
authors.lastname: van der Geer
authors.forename: J
authors.initials: J
authors.lastname: Martens
authors.forename: J
authors.initials: J
authors.lastname: van Roij
authors.forename: E
authors.initials: E
authors.lastname: Brand
authors.forename: J U
authors.initials: JU
authors.lastname: Ostertag
authors.forename: M E J M
authors.initials: ME
authors.lastname: Verhaegh
authors.forename: H A M
authors.initials: HA
authors.lastname: Neumann
authors.forename: G A M
authors.initials: GA
authors.lastname: Krekels
mesh_terms: D000276:Adjuvants, Immunologic / Q000008:administration & dosage* / Q000009:adverse effects; D000279:Administration, Cutaneous; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage* / Q000009:adverse effects; D002280:Basal Cell Carcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D005153:Facial Neoplasms / Q000188:drug therapy / Q000601:surgery*; D005260:Female; D006801:Humans; D000077271:Imiquimod; D008297:Male; D008875:Middle Aged; D015580:Mohs Surgery / Q000379:methods*; D009824:Ointments; D011300:Preoperative Care; D011446:Prospective Studies; D012878:Skin Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016896:Treatment Outcome; D047368:Tumor Burden
chemical_list: D000276:Adjuvants, Immunologic; D000634:Aminoquinolines; D009824:Ointments; D000077271:Imiquimod