Imiquimod 5% cream for the treatment of large nodular basal cell carcinoma at the medial canthal area

Abstract

Context (Background):Imiquimod (IMQ) 5% cream is an immunomodulatory and antitumorigenic agent, which was used as a topical treatment regimen, who had periocular basal cell carcinoma (BCC).Aim:This study aims to present three cases with large BCC at the medial canthal area treated with IMQ 5% cream.Materials and Methods:IMQ 5% cream was used in three patients with ages 45, 49, and 73 who preferred medical treatment over surgery. Following incisional biopsy IMQ cream was used once a day, 5 times a week and the patients were followed up weekly during 12 week treatment period and monthly after the clearance of the lesion.Results:Erythema and erosion on the surface of the lesion, injection of conjunctiva, burning and itching sensation, epiphora and punctate keratitis were seen in all patients during the treatment period. The ophthalmic side effects could be managed by topical lubricating eye drops and the inflammatory reactions resolved within 1 month after cessation of therapy. The patients were followed up for at least 3 years without tumor recurrence and the biopsies taken from the suspected area were found to be tumor free.Conclusion:Surgical excision of carcinoma of the eyelid at medial canthal area can be difficult without causing damage to the lacrimal system and reconstruction of the defect may need grafts or flaps. IMQ may provide an alternative therapy to surgery in certain cases.

Bilateral ocular surface squamous neoplasia with bilateral periocular basal cell carcinoma in a case of xeroderma pigmentosum

“…There is one case report by Giannotti et al in which imiquimod has been used in XP for treatment of skin tumours with resolution 10. Imiquimod cream is a good alternative to surgery for medial canthal BCC as surgical excision can damage the lacrimal system and reconstruction of defects needs grafts and flaps 11. In our case, right-sided BCC was treated by surgery and the left-sided BCC was treated with topical imiquimod, with a good response.…”

Treatment of squamous cell carcinoma of the eyelid with imiquimod 5% cream

“…[4][5][6][7] Although the manufacturer recommends that this cream not be used in the periocular region, cautious application only to the lesion has delivered promising results. 8 Surgical excision of eyelid malignancy with histopathological free margins followed by eyelid reconstruction still is considered the gold standard by many surgeons, but in difficult areas such as the medial canthus region, non-surgical treatment modalities have been attempted. 1,2 Moreover, in a randomized controlled trial (SINS trial) including patients with BCC, treatment with imiquimod 5% cream produced better cosmetic and functional results.…”

“…2,3 Such clinical features are shared in common with mitochondrial disorders such as Leber's hereditary optic neuropathy (LHON) and suggest adjunctive etiologies involving mitochondrial dysfunction and mitochondrial DNA (mtDNA) in WS pathophysiology. [6][7][8][9][10][11][12] Microvascular changes in the optic nerve head (ONH) and peripapillary retinal blood supply have been demonstrated in well-established mitochondrial diseases such as Leber's hereditary optic neuropathy (LHON) and dominant optic atrophy (DOA). 13 The advent of a new optical coherence tomography (OCT) technology, called…”

Successful treatment of multifocal pigmented basal cell carcinomas with the application of topical 5% imiquimod cream

“…Basal cell carcinoma (BCC) is the most common nonmelanocytic skin cancer and its incidence increases mostly with age and accumulated sun exposure (Lai, Cranwell, & Sinclair, ). So far the surgical excision with narrow safety margins has been considered to be the gold standard treatment for this type of skin tumor (Karabulut et al, ). However this option is not always possible.…”