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.

Study design: 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.

Trial registration: ClinicalTrial.gov Registration Dec 3, 2008: # NCT 00803907.

Trial registration: ClinicalTrials.gov NCT00803907.

Figure 1

Imiquimod (IMQ) treatment flow chart.

Figure 2

Lesion #12. Nodular basal cell carcinoma in the medial canthus. A) before treatment, B) local inflammation mimicking preseptal cellulitis, C) 2 years after treatment completion, when the biopsy identified BCC recurrence.

Figure 3

Clinical pictures before and 3 years after treatment. A) Case #13: Eyelid margin PNBCC, B) after treatment, C) case #4, medial canthus PNBCC, D) after treatment.