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Scurtu LG, Petrica M, Grigore M, Avram A, Popescu I, Simionescu O. A Conservative Combined Laser Cryoimmunotherapy Treatment vs. Surgical Excision for Basal Cell Carcinoma. J Clin Med 2022; 11:jcm11123439. [PMID: 35743507 PMCID: PMC9224731 DOI: 10.3390/jcm11123439] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Revised: 06/09/2022] [Accepted: 06/13/2022] [Indexed: 02/01/2023] Open
Abstract
Surgical excision is the standard treatment for basal cell carcinoma (BCC), but it can be challenging in elderly patients and patients with comorbidities. The non-surgical guidelines procedures are usually regarded as monotherapy options. This quasi-experimental, non-randomized, comparative effectiveness study aims to evaluate the efficacy of a combined, conservative, non-surgical BCC treatment, and compare it to standard surgical excision. Patients with primary, non-ulcerated, histopathologically confirmed BCCs were divided into a conservative treatment (129 patients) and a standard surgery subgroup (50 patients). The conservative treatment consisted of ablative CO2 laser, cryosurgery, topical occlusive 5-fluorouracil, and imiquimod. The follow-up examinations were performed 3 months after remission, then every 3 to 6 months, and were extended with telephone follow-ups. Cosmetic-self assessment was recorded during a telephone follow-up. Subjects from the conservative subgroup presented a clearance rate of 99.11%, and a recurrence rate of 0.98%. No recurrences were recorded in the surgical group, nor during the telephone follow-up. There were no differences regarding adverse events (p > 0.05). A superior self-assessment cosmetic outcome was obtained using the conservative method (p < 0.001). This conservative treatment is suitable for elders and patients with comorbidities, is not inferior to surgery in terms of clearance, relapses, or local adverse events, and displays superior cosmetic outcomes.
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Affiliation(s)
- Lucian G. Scurtu
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Marian Petrica
- Faculty of Mathematics and Computer Science, University of Bucharest, 010014 Bucharest, Romania; (M.P.); (I.P.)
- Institute of Mathematical Statistics and Applied Mathematics of the Romanian Academy, 050711 Bucharest, Romania
| | - Mariana Grigore
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Alina Avram
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
| | - Ionel Popescu
- Faculty of Mathematics and Computer Science, University of Bucharest, 010014 Bucharest, Romania; (M.P.); (I.P.)
- Institute of Mathematics of the Romanian Academy, 010702 Bucharest, Romania
| | - Olga Simionescu
- Department of Dermatology I, Colentina Hospital, “Carol Davila” University of Medicine and Pharmacy, 19-21 Stefan Cel Mare Road, 020125 Bucharest, Romania; (L.G.S.); (M.G.); (A.A.)
- Correspondence: ; Tel.: +40-74-241-8662
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Sinx KAE, Mosterd K, de Coster D, Essers BA. Patient preferences for curettage followed by imiquimod 5% cream vs. surgical excision for the treatment of non-facial nodular basal cell carcinoma: a discrete choice experiment. J Eur Acad Dermatol Venereol 2021; 36:e41-e43. [PMID: 34416061 DOI: 10.1111/jdv.17611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- K A E Sinx
- GROW Research Institute for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - K Mosterd
- GROW Research Institute for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - D de Coster
- Maastricht University, Maastricht, The Netherlands
| | - B A Essers
- Clinical Epidemiology and Medical Technology Assessment Maastricht University Medical Center, Maastricht, The Netherlands
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Kash N, Silapunt S. A review of emerging and non-US FDA-approved topical agents for the treatment of basal cell carcinoma. Future Oncol 2021; 17:3111-3132. [PMID: 34156307 DOI: 10.2217/fon-2020-1147] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Although surgical therapy continues to be the gold standard for the treatment of basal cell carcinoma given high cure rates and the ability to histologically confirm tumor clearance, there are a number of nonsurgical treatment options that may be considered based on individual tumor characteristics, functional and cosmetic considerations, patient comorbidities and patient preference. Topical 5-fluorouracil 5% cream and imiquimod 5% cream have been US FDA-approved for the treatment of superficial basal cell carcinoma. Additionally, a number of new and emerging topical agents and techniques have been described for the treatment of basal cell carcinoma and will be reviewed herein.
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Affiliation(s)
- Natalie Kash
- Department of Dermatology, Kansas City University-Graduate Medical Education Consortium/Advanced Dermatology & Cosmetic Surgery Orlando Program, Maitland, FL 32751, USA
| | - Sirunya Silapunt
- Department of Dermatology, University of Texas McGovern Medical School at Houston, Houston, TX 77030, USA
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[Surgical techniques in the treatment of basal cell carcinoma-a prospective investigation]. Hautarzt 2020; 71:960-968. [PMID: 32930855 PMCID: PMC7686215 DOI: 10.1007/s00105-020-04685-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Hintergrund Basalzellkarzinome sind die häufigsten epithelialen Hauttumoren und eine häufige Indikation für dermatologische Eingriffe. Trotz der Etablierung medikamentöser Therapieoptionen stellt die Operation weiterhin die Therapie der Wahl dar. Hierbei stehen verschiedene Möglichkeiten zur Verfügung, die von der Kürettage bis hin zu komplexen dermatochirurgischen Eingriffen reichen. Neben dem Hauptaspekt der geringen lokalen Rezidivraten sind auch ästhetische Faktoren und die Anzahl der Eingriffe für die Wahl der Therapie wichtig. Methoden In dieser Studie wurden 347 Patienten mit 398 Basalzellkarzinomen (nodulärer Typ, Durchmesser bis 10 mm) prospektiv untersucht. Die Patienten wurden randomisiert in 2 Behandlungsarme eingeteilt: In einer Gruppe wurden die Tumoren kürettiert, in der anderen Gruppe exzidiert. Als Kontrolle dienten Patienten, die im gleichen Untersuchungszeitraum 3‑D-histologisch kontrolliert operiert wurden. Ergebnisse Die höchste lokale Rezidivrate wurde nach der Kürettage (14,0 %) beobachtet, während die Gruppe mit 3‑D-Histologie die niedrigste Rezidivrate (0,9 %; p < 0,001) aufwies. In der 3‑D-Gruppe waren mehr Re-Exzisionen erforderlich, um eine vollständige Entfernung des Tumors zu erreichen, als in der Gruppe mit histologischen Serienschnitten. Die Patienten bewerteten das ästhetische Ergebnis am besten nach der Kürettage. Die mittlere Nachbeobachtungszeit betrug 3,9 Jahre. Schlussfolgerung Die Wahl der chirurgischen Therapie bei kleinen nodulären Basalzellkarzinomen hängt von den individuellen Gegebenheiten ab. 3‑D-histologisch kontrollierte Exzisionen mit Wundverschluss nach vollständiger Tumorentfernung zeigten in unserer Studie die geringste Rezidivrate. Aber auch die Kürettage stellt eine mögliche chirurgische Therapieoption mit minimalem Aufwand und einer akzeptablen Rezidivrate dar, die zu guten ästhetischen Ergebnissen führen kann.
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Sinx KAE, Nelemans PJ, Kelleners-Smeets NWJ, Winnepenninckx VJL, Arits AHMM, Mosterd K. Surgery versus combined treatment with curettage and imiquimod for nodular basal cell carcinoma: One-year results of a noninferiority, randomized, controlled trial. J Am Acad Dermatol 2020; 83:469-476. [PMID: 32320773 DOI: 10.1016/j.jaad.2020.04.053] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 04/06/2020] [Accepted: 04/10/2020] [Indexed: 11/25/2022]
Abstract
PURPOSE Nodular basal cell carcinoma (nBCC) is mostly treated with surgical excision. Interest in minimally invasive treatment of these low-risk tumors is increasing. We assessed the effectiveness of nBCC treatment with curettage and imiquimod cream compared with surgical excision. METHODS Patients with nBCC included in this randomized, controlled noninferiority trial were randomly assigned to either a curettage and imiquimod cream group or a surgical excision group. The primary endpoint was the proportion of patients free from treatment failure 1 year after the end of treatment. A prespecified noninferiority margin of 8% was used. A modified intention-to-treat and a per-protocol analysis was performed (ClinicalTrials.gov identifier NCT02242929). RESULTS One hundred forty-five patients were randomized: 73 to the curettage and imiquimod cream group and 72 to the surgical excision group. The proportion of patients free of recurrence after 12 months was 86.3% (63/73) for the curettage and imiquimod group and 100% (72/72) for the surgical excision group. The difference in efficacy was -13.7% (95% confidence interval -21.6% to -5.8%; 1-sided P = .0004) favoring surgical excision. CONCLUSION Noninferiority of curettage and imiquimod cream cannot be concluded. Given the still high efficacy of curettage and imiquimod cream and the indolent growth pattern of nBCC, curettage and imiquimod could still be a valuable treatment option with the possibility to prevent overuse of excisions. However, it cannot replace surgical excision.
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Affiliation(s)
- Kelly A E Sinx
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands.
| | - Patty J Nelemans
- Department of Epidemiology, Maastricht University, Maastricht, The Netherlands
| | - Nicole W J Kelleners-Smeets
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
| | | | - Aimee H M M Arits
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands; Department of Pathology, Maastricht University Medical Center, Maastricht, The Netherlands; Department of Dermatology, Catharina Hospital, Eindhoven, The Netherlands
| | - Klara Mosterd
- Department of Dermatology, Maastricht University Medical Center, Maastricht, The Netherlands; GROW Research Institute for Oncology and Developmental Biology, Maastricht University, Maastricht, The Netherlands
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Peris K, Fargnoli MC, Garbe C, Kaufmann R, Bastholt L, Seguin NB, Bataille V, Marmol VD, Dummer R, Harwood CA, Hauschild A, Höller C, Haedersdal M, Malvehy J, Middleton MR, Morton CA, Nagore E, Stratigos AJ, Szeimies RM, Tagliaferri L, Trakatelli M, Zalaudek I, Eggermont A, Grob JJ. Diagnosis and treatment of basal cell carcinoma: European consensus–based interdisciplinary guidelines. Eur J Cancer 2019; 118:10-34. [DOI: 10.1016/j.ejca.2019.06.003] [Citation(s) in RCA: 129] [Impact Index Per Article: 25.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2019] [Revised: 06/18/2019] [Accepted: 06/18/2019] [Indexed: 10/26/2022]
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Terapia fotodinámica versus imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012; 103:488-501. [DOI: 10.1016/j.ad.2011.10.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2011] [Revised: 09/27/2011] [Accepted: 10/02/2011] [Indexed: 11/22/2022] Open
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Serra-Guillén C, Nagore E, Guillén C. Photodynamic Therapy vs Imiquimod. ACTAS DERMO-SIFILIOGRAFICAS 2012. [DOI: 10.1016/j.adengl.2012.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
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9
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Treatment of facial Basal cell carcinoma: a review. J Skin Cancer 2011; 2011:380371. [PMID: 21773034 PMCID: PMC3135095 DOI: 10.1155/2011/380371] [Citation(s) in RCA: 40] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2010] [Revised: 01/23/2011] [Accepted: 01/27/2011] [Indexed: 11/17/2022] Open
Abstract
Basal cell carcinomas (BCCs) are locally destructive malignancies of
the skin. They are the most common type of cancer in the western
world. The lifetime incidence may be up to 39%. UV exposure is the
most common risk factor. The majority of these tumours occur on the
head and neck. Despite BCCs being relatively indolent the high
incidence means that their treatment now contributes a significant and
increasing workload for the health service. A good understanding of
the options available is important. Management decisions may be
influenced by various factors including the patient's age and
comorbidities and the lesion subtype and location. Due to the
importance of a good cosmetic and curative outcome for facial BCCs
treatment decisions may differ significantly to those that would be
made for BCCs arising elsewhere. There is little good randomized
controlled data available comparing treatment modalities. Although
traditionally standard excision has been the treatment of choice
various other options are available including: Mohs micrographic
surgery, curettage and cautery, cryosurgery, radiotherapy, topical
imiquimod, photodynamic therapy and topical 5-fluorouracil. We
discuss and review the literature and evidence base for the treatment
options that are currently available for facial BCCs.
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Garcia-Martin E, Idoipe M, Gil LM, Pueyo V, Alfaro J, Pablo LE, Zubiri ML, Fernandez J. Efficacy and tolerability of imiquimod 5% cream to treat periocular basal cell carcinomas. J Ocul Pharmacol Ther 2011; 26:373-9. [PMID: 20698800 DOI: 10.1089/jop.2010.0030] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To assess the efficacy and safety of nonsurgical treatment with imiquimod (IMQ) 5% cream in patients with periocular nodular basal cell carcinoma (BCC). METHODS Fifteen patients with clinical and histopathological diagnosis of nodular BCC on the eyelid were treated with IMQ 5% cream once daily, 5 days/week for 6 weeks. Three patients had tumor persistence after photodynamic therapy and 1 patient had failed cryotherapy. RESULTS All tumors showed histopathological remission within 3 months of starting IMQ, and sustained clinical remission was documented in each patient after 24-28 months' follow-up. Treatment tolerability was bad in 7 patients with local effects being most problematic, but all symptoms disappeared when treatment ended. CONCLUSIONS IMQ therapy is effective for treating periocular BCCs with a cure rate similar to that of surgery. Aesthetic results were rated as excellent. IMQ is a useful alternative to surgery in patients with periocular BCCs when other therapies have failed or are not possible.
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Affiliation(s)
- Elena Garcia-Martin
- Ophthalmology Department, Miguel Servet Universitary Hospital, Zaragoza, Spain.
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11
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Nonsurgical treatment options for Basal cell carcinoma. J Skin Cancer 2011; 2011:571734. [PMID: 21274437 PMCID: PMC3025364 DOI: 10.1155/2011/571734] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2010] [Accepted: 11/16/2010] [Indexed: 11/23/2022] Open
Abstract
Basal cell carcinoma (BCC) remains the most common form of nonmelanoma skin cancer (NMSC) in Caucasians, with perhaps as many as 2 million new cases expected to occur in the United States in 2010. Many treatment options, including surgical interventions and nonsurgical alternatives, have been utilized to treat BCC. In this paper, two non-surgical options, imiquimod therapy and photodynamic therapy (PDT), will be discussed. Both modalities have demonstrated acceptable disease control rates, cosmetically superior outcomes, and short-term cost-effectiveness. Further studies evaluating long-term cure rates and long-term cost effectiveness of imiquimod therapy and PDT are needed.
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Micali G, Lacarrubba F, Dinotta F, Massimino D, Nasca MR. Treating skin cancer with topical cream. Expert Opin Pharmacother 2010; 11:1515-27. [DOI: 10.1517/14656566.2010.481284] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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13
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Gowda S, Tillman DK, Fitzpatrick JE, Gaspari AA, Goldenberg G. Imiquimod-induced vitiligo after treatment of nodular basal cell carcinoma. J Cutan Pathol 2009; 36:878-81. [DOI: 10.1111/j.1600-0560.2008.01134.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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14
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Abstract
Superficial basal cell carcinoma comprise up to 25% of all histological sub-types. They are more likely to occur on younger persons and females and although generally more common on the trunk, also occur frequently on the exposed areas of the head and neck especially in areas of high sun exposure. In the last decade, new treatment options such as topical applications that modify the immune response have been trialed for effectiveness in treating these lesions. Imiquimod 5% cream has been shown to stimulate the innate and cell mediated immune system. The short-term success of imiquimod 5% cream in randomized controlled trials comparing different treatment regimes and dosing as a treatment for small superficial basal cell carcinoma (BCC) not on the face or neck is in the range of 82% for 5 times per week application. A high proportion of participants with good response rates to topical treatment (58%–92%) experience local side effects such as itching and burning, less commonly erosion and ulceration, but the proportion of participants ceasing treatment has not been high. To date one long-term study indicates a treatment success rate of 78%–81% and that initial response is a predictor of long-term outcome. Recurrences tend to occur within the first year after treatment. Future research will compare this preparation to the gold standard treatment for superficial BCC – surgical excision.
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Affiliation(s)
- Beverly Raasch
- Skin Cancer Research Group, North Queensland Centre for Cancer Research, James Cook University, Queensland, Australia
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Abstract
This article represents a planned regular updating of the previous British Association of Dermatologists guidelines for the management of basal cell carcinoma. These guidelines present evidence-based guidance for treatment, with identification of the strength of evidence available at the time of preparation of the guidelines, and a brief overview of epidemiological aspects, diagnosis and investigation.
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Affiliation(s)
- N R Telfer
- Dermatology Centre, Salford Royal Hospitals NHS Foundation Trust, Manchester M6 8HD, UK.
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Neville JA, Welch E, Leffell DJ. Management of nonmelanoma skin cancer in 2007. ACTA ACUST UNITED AC 2007; 4:462-9. [PMID: 17657251 DOI: 10.1038/ncponc0883] [Citation(s) in RCA: 160] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2007] [Accepted: 04/26/2007] [Indexed: 11/08/2022]
Abstract
As the incidence of nonmelanoma skin cancer (NMSC) increases, so does the number of modalities used to treat this condition. Surgery is the most frequent approach used to treat NMSC, and clinicians usually perform Mohs micrographic surgery, conventional excision, electrodesiccation and curettage or cryosurgery. The 'gold standard' for treatment continues to be Mohs micrographic surgery, but owing to the time and expense involved with this procedure, it is indicated only in patients with aggressive tumors or those where disfigurement or functional impairment is a risk. Although radiation therapy is effective, its use is limited because of the side effects induced; radiation therapy can be used in certain patients who are not surgical candidates. Newer noninvasive options for NMSC include topical chemotherapeutics, biological-immune-response modifiers, retinoids, and photodynamic therapy, which can be used particularly in patients with superficial tumors. Treatments should be tailored to tumor type, location, size, and histological pattern, and although surgical methods remain the most frequently used, newer noninvasive treatments can be used in select tumors and may reduce morbidity.
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Papadavid E, Stratigos AJ, Falagas ME. Imiquimod: an immune response modifier in the treatment of precancerous skin lesions and skin cancer. Expert Opin Pharmacother 2007; 8:1743-55. [PMID: 17685890 DOI: 10.1517/14656566.8.11.1743] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Actinic keratosis (AK) and basal cell carcinoma (BCC) are precancerous and cancerous skin lesions that should be treated especially when multiple or in cosmetically important areas. Apart from 5% 5-fluorouracil topical cream, which some feel is the gold standard topical treatment for AK, several invasive treatment modalities are available for AK and superficial BCC, such as cryotherapy, electrodessication, carbon dioxide laser and surgery causing patients discomfort and pain, pigmentary changes or necessitate multiple office visits. Additionally, there are precancerous lesions that necessitate non-invasive treatment with good esthetic results or skin cancer refractory to invasive techniques. Imiquimod is an immune response modifier approved by the FDA for the treatment of AK and superficial BCC lesions and its use is gradually expanded to various off-label precancerous and cancerous skin lesions.
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Affiliation(s)
- Evangelia Papadavid
- 2nd Department of Dermatology, ATTIKON University General Hospital, University of Athens Medical School, Athens, Greece
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