What is the role of imiquimod in the management of basal cell carcinoma (BCC)?

Updated: Mar 02, 2020
  • Author: Robert S Bader, MD; Chief Editor: William D James, MD  more...
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Answer

Imiquimod 5% cream (Aldara) is approved by the US Food and Drug Administration for the treatment of nonfacial superficial BCC. [80, 81] Several studies have shown imiquimod to be curative in all patients with superficial BCC if used twice daily and in 73-82% of patients when used once a day for 6-12 weeks. Smaller studies have shown similar responses for nodular BCC. Studies for other histologic types of BCC are under way. [19, 20, 23, 22, 21, 24]

Treatment is often initiated at 3-7 times per week and the dosage is increased as tolerated to once or twice daily, to maintain mild-to-moderate skin irritation. [82, 83] Patients can titrate the frequency of application to maintain low-to-moderate skin irritation. A 12-week course of treatment is often used, which does not need be contiguous. [74]

In a study of 601 patients with histologically proven superficial basal-cell carcinoma, topical imiquimod cream (once daily, 5 times a week, for 6 weeks) was superior, and topical fluorouracil (twice daily for 4 weeks) was noninferior, to methylaminolevulinate photodynamic therapy (2 sessions with an interval of 1 week). At both 3- and 12-month follow-up, the proportion of patients who were tumor-free was 72.8% for methylaminolevulinate photodynamic therapy, 83.4% for imiquimod cream, and 80.1% for fluorouracil cream. [84]


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