Imiquimod as Pretreatment of Mohs Surgery for Nodular BCC
Imiquimod as Pretreatment of Mohs Surgery for Nodular BCC
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.
Objectives 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.
Basal cell carcinoma (BCC) is the most common malignancy of the skin. While the mortality rate due to this tumour is insignificant, an increasing group of especially younger patients is concerned about the cosmetic outcome of the treatment of a facial tumour. Various therapeutic modalities exist. In most cases surgical excision will take place. Mohs micrographic surgery (MMS) is an advanced technique used mainly for BCCs in the face that have a high risk for recurrence, are located in the H-zone or have a diameter of >2 cm. The size of the defect after excision of the tumour can be significantly reduced by using MMS, compared with the standard surgical excision. The cosmetic outcome is therefore overall better.
Mohs micrographic surgery has the lowest recurrence rate in the treatment of BCC. It is, however, a time-consuming method and therefore costs are higher. Nonsurgical treatments for BCC are available, such as imiquimod 5% cream (Aldara®; Meda, Solna, Sweden), an immune response modifier. Studies have shown that imiquimod has a beneficial effect on small superficial and small nodular BCCs, and total or partial clearance is obtained.
Adverse events that have been reported are mainly mild local skin reactions: these include erythema, itching, pain, erosions and excoriations. Systemic reactions are described as well. Imiquimod has been used as an adjuvant treatment for MMS before.
In this study we investigated the effect of a treatment with imiquimod 5% cream before MMS for medium-sized nodular (or nodular and partially superficial) BCC in the face. We hypothesized that this pretreatment could reduce the tumour size and could result in a smaller defect after MMS.
Abstract and Introduction
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.
Objectives 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.
Introduction
Basal cell carcinoma (BCC) is the most common malignancy of the skin. While the mortality rate due to this tumour is insignificant, an increasing group of especially younger patients is concerned about the cosmetic outcome of the treatment of a facial tumour. Various therapeutic modalities exist. In most cases surgical excision will take place. Mohs micrographic surgery (MMS) is an advanced technique used mainly for BCCs in the face that have a high risk for recurrence, are located in the H-zone or have a diameter of >2 cm. The size of the defect after excision of the tumour can be significantly reduced by using MMS, compared with the standard surgical excision. The cosmetic outcome is therefore overall better.
Mohs micrographic surgery has the lowest recurrence rate in the treatment of BCC. It is, however, a time-consuming method and therefore costs are higher. Nonsurgical treatments for BCC are available, such as imiquimod 5% cream (Aldara®; Meda, Solna, Sweden), an immune response modifier. Studies have shown that imiquimod has a beneficial effect on small superficial and small nodular BCCs, and total or partial clearance is obtained.
Adverse events that have been reported are mainly mild local skin reactions: these include erythema, itching, pain, erosions and excoriations. Systemic reactions are described as well. Imiquimod has been used as an adjuvant treatment for MMS before.
In this study we investigated the effect of a treatment with imiquimod 5% cream before MMS for medium-sized nodular (or nodular and partially superficial) BCC in the face. We hypothesized that this pretreatment could reduce the tumour size and could result in a smaller defect after MMS.