title: Imiquimod cream efficacy in the treatment of periocular nodular basal cell carcinoma: a non-randomized trial.
abstract: BACKGROUND
  The recurrence rate of periocular nodular basal cell carcinoma (PNBCC) following treatment with imiquimod (IMQ) has not yet been established. Previous studies did not include histological follow-up. The aim of this analysis was to evaluate the efficacy of topical immunotherapy with 5% IMQ cream for the treatment of PNBCC.
  
  
  METHODS
  
  
  
  METHODS
  A prospective, non-randomized, and uncontrolled longitudinal case series study. No participants were blinded. Punch biopsy confirmed PNBCC patients were included at the Ophthalmology Clinic of São Paulo University Medicine School Hospital (from 2008 to 2012). Patients were treated with 5% IMQ cream once a day, 5 days per week, for 8-16 weeks. Standard lesion photographic documentation was done during the study. Three months after treatment ended, an image-guided biopsy was performed. Patients were followed at 6-month intervals and annually for control biopsies. Main outcome measures were clinical and histological clearance rates. Data were analysed by frequency distribution for qualitative group characteristics and central tendency measures for quantitative data.
  
  
  RESULTS
  Twenty-four patients met the inclusion criteria, 19 of whom remained until the end of treatment. The histological clearance rate was 89.5% and 84.2%, respectively, at 3 and 39.5 months. The 3-year histological clearance rate was 81.8% (9/11) for lesions >10 mm, and 100% (8/8) for lesions <10 mm. Three patients did not tolerate the side effects of the medication and left the study. Two patients were excluded for treatment interruption related to comorbidities.
  
  
  CONCLUSIONS
  Our results indicated that 5% IMQ cream was a useful alternative treatment for NBBCC, especially for lesions <10 mm. IMQ also showed a significant neoadjuvant effect on lesions >10 mm.
  
  
  BACKGROUND
  ClinicalTrial.gov Registration Dec 3, 2008: # NCT 00803907.
authors.affiliation: Departments of Ophthalmology and Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, Brazil. erickmarcet@yahoo.com.br.
authors.forename: Erick Marcet Santiago
authors.initials: EM
authors.lastname: de Macedo
authors.affiliation: Departments of Ophthalmology and Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, Brazil. rccarneiro@msn.com.
authors.forename: Rachel Camargo
authors.initials: RC
authors.lastname: Carneiro
authors.affiliation: Departments of Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, Brazil. patpicciarelli@yahoo.com.br.
authors.forename: Patricia Picciarelli
authors.initials: PP
authors.lastname: de Lima
authors.affiliation: Departments of Ophthalmology and Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, Brazil. breno_bgs@hotmail.com.
authors.forename: Breno Gonçalves
authors.initials: BG
authors.lastname: Silva
authors.affiliation: Departments of Ophthalmology and Pathology, University of São Paulo School of Medicine, Av. Dr. Arnaldo, 455, São Paulo, Brazil. suzana.matayoshi@gmail.com.
authors.forename: Suzana
authors.initials: S
authors.lastname: Matayoshi
mesh_terms: D000287:Administration, Topical; D000368:Aged; D000634:Aminoquinolines / Q000008:administration & dosage*; D000970:Antineoplastic Agents / Q000008:administration & dosage; D002280:Basal Cell Carcinoma / Q000175:diagnosis / Q000188:drug therapy*; D005142:Eyelid Neoplasms / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D000077271:Imiquimod; D008297:Male; D009364:Neoplasm Recurrence, Local; D011446:Prospective Studies; D063465:Skin Cream / Q000008:administration & dosage; D016896:Treatment Outcome
chemical_list: D000634:Aminoquinolines; D000970:Antineoplastic Agents; D000077271:Imiquimod