Imiquimod Effective for Treating Squamous, Basal Cell Carcinoma

WILLIAMSBURG, VA. — Imiquimod can be a powerful tool for fighting in situ squamous cell carcinomas and superficial basal cell carcinomas, Dr. Roger Ceilley said.

"A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas," said Dr. Ceilley, at the annual meeting of the American Society for Mohs Surgery. "We may worry that when treating carcinoma in situ topically, that we are just treating the tip of the iceberg, but there are a few studies now that show even patients with an early invasive squamous cell carcinoma [SCC] treated three times a week for 12 weeks show clearing of the deeper component of the lesion."

Evidence is mounting for imiquimod's use on various sites of SCC in situ, including lesions on the anterior leg and penis, said Dr. Ceilley, a professor of dermatology at the University of Iowa, Iowa City. He noted seven case reports of imiquimod used successfully to treat penile lesions. The cream was applied anywhere from twice a week to every other day, depending on individual tolerance, for 8-16 weeks. "This is clearly an off-label use and you wouldn't want to do it without consulting a urologist but, with close management, this might be an alternative for an SCC that would otherwise result in a penectomy," he said.

Combined with 5-fluorouracil, imiquimod is especially effective for SCC lesions on the scalp, and dorsum of the hand—places that are often resistant to either treatment alone.

The cream also is approved for use in superficial basal cell carcinoma, where it has shown effectiveness. A 2004 placebo-controlled study found that up to 82% of patients had histologic clearance after a 6-week treatment cycle (J. Am. Acad. Dermatol. 2004;50:722-33). The study also found no significant difference in clearance rates among patients who used the cream five or seven times a week, lending support for the shorter treatment time. However, clearance was highly correlated with increased severity of erythema, erosion, and scabbing or crusting. The cosmetic outcomes were excellent.

For BCC, Dr. Ceilley said he prefers to use imiquimod prior to Mohs surgery, in conjunction with aggressive curettage and electrodesiccation. Treating for a few weeks preoperatively can reduce the defect, decrease the frequency of residual tumor, and improve cosmetic appearance.

"You can really define the lesions more carefully, minimizing the area of surgery you have to do," he said.

Evidence is mounting for the use of imiquimod in nodular BCC as well—especially in smaller, low-risk lesions or as adjunctive therapy. The original 2002 dosing study found a histologic clearance rate of up to 76%, with no significant difference between those who applied the medication daily for 12 or 16 weeks (Arch. Dermatol. 2002;138:1165-71), said Dr. Ceilley.

A more recent study found that while 70 of 90 patients (78%) had a complete clinical response, there was clinically visible tumor still present in 20 patients (22%). There was complete histopathologic clearance observed in 58 patients (64%), while residual tumor remained in 32 patients (36%). Efficacy was better in lesions smaller than 1 cm in diameter. The authors concluded that, since 17% of patients in the study with clinical clearance still had pathologic evidence of disease, excisional biopsy of the treated site is still indicated (J. Am. Acad. Dermatol. 2007;57:616-21).

Dr. Ceilley stated that he did not have any conflicts of interest to disclose.

'A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas.' DR. CEILLEY

WILLIAMSBURG, VA. — Imiquimod can be a powerful tool for fighting in situ squamous cell carcinomas and superficial basal cell carcinomas, Dr. Roger Ceilley said.

"A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas," said Dr. Ceilley, at the annual meeting of the American Society for Mohs Surgery. "We may worry that when treating carcinoma in situ topically, that we are just treating the tip of the iceberg, but there are a few studies now that show even patients with an early invasive squamous cell carcinoma [SCC] treated three times a week for 12 weeks show clearing of the deeper component of the lesion."

Evidence is mounting for imiquimod's use on various sites of SCC in situ, including lesions on the anterior leg and penis, said Dr. Ceilley, a professor of dermatology at the University of Iowa, Iowa City. He noted seven case reports of imiquimod used successfully to treat penile lesions. The cream was applied anywhere from twice a week to every other day, depending on individual tolerance, for 8-16 weeks. "This is clearly an off-label use and you wouldn't want to do it without consulting a urologist but, with close management, this might be an alternative for an SCC that would otherwise result in a penectomy," he said.

Combined with 5-fluorouracil, imiquimod is especially effective for SCC lesions on the scalp, and dorsum of the hand—places that are often resistant to either treatment alone.

The cream also is approved for use in superficial basal cell carcinoma, where it has shown effectiveness. A 2004 placebo-controlled study found that up to 82% of patients had histologic clearance after a 6-week treatment cycle (J. Am. Acad. Dermatol. 2004;50:722-33). The study also found no significant difference in clearance rates among patients who used the cream five or seven times a week, lending support for the shorter treatment time. However, clearance was highly correlated with increased severity of erythema, erosion, and scabbing or crusting. The cosmetic outcomes were excellent.

For BCC, Dr. Ceilley said he prefers to use imiquimod prior to Mohs surgery, in conjunction with aggressive curettage and electrodesiccation. Treating for a few weeks preoperatively can reduce the defect, decrease the frequency of residual tumor, and improve cosmetic appearance.

"You can really define the lesions more carefully, minimizing the area of surgery you have to do," he said.

Evidence is mounting for the use of imiquimod in nodular BCC as well—especially in smaller, low-risk lesions or as adjunctive therapy. The original 2002 dosing study found a histologic clearance rate of up to 76%, with no significant difference between those who applied the medication daily for 12 or 16 weeks (Arch. Dermatol. 2002;138:1165-71), said Dr. Ceilley.

A more recent study found that while 70 of 90 patients (78%) had a complete clinical response, there was clinically visible tumor still present in 20 patients (22%). There was complete histopathologic clearance observed in 58 patients (64%), while residual tumor remained in 32 patients (36%). Efficacy was better in lesions smaller than 1 cm in diameter. The authors concluded that, since 17% of patients in the study with clinical clearance still had pathologic evidence of disease, excisional biopsy of the treated site is still indicated (J. Am. Acad. Dermatol. 2007;57:616-21).

Dr. Ceilley stated that he did not have any conflicts of interest to disclose.

'A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas.' DR. CEILLEY

WILLIAMSBURG, VA. — Imiquimod can be a powerful tool for fighting in situ squamous cell carcinomas and superficial basal cell carcinomas, Dr. Roger Ceilley said.

"A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas," said Dr. Ceilley, at the annual meeting of the American Society for Mohs Surgery. "We may worry that when treating carcinoma in situ topically, that we are just treating the tip of the iceberg, but there are a few studies now that show even patients with an early invasive squamous cell carcinoma [SCC] treated three times a week for 12 weeks show clearing of the deeper component of the lesion."

Evidence is mounting for imiquimod's use on various sites of SCC in situ, including lesions on the anterior leg and penis, said Dr. Ceilley, a professor of dermatology at the University of Iowa, Iowa City. He noted seven case reports of imiquimod used successfully to treat penile lesions. The cream was applied anywhere from twice a week to every other day, depending on individual tolerance, for 8-16 weeks. "This is clearly an off-label use and you wouldn't want to do it without consulting a urologist but, with close management, this might be an alternative for an SCC that would otherwise result in a penectomy," he said.

Combined with 5-fluorouracil, imiquimod is especially effective for SCC lesions on the scalp, and dorsum of the hand—places that are often resistant to either treatment alone.

The cream also is approved for use in superficial basal cell carcinoma, where it has shown effectiveness. A 2004 placebo-controlled study found that up to 82% of patients had histologic clearance after a 6-week treatment cycle (J. Am. Acad. Dermatol. 2004;50:722-33). The study also found no significant difference in clearance rates among patients who used the cream five or seven times a week, lending support for the shorter treatment time. However, clearance was highly correlated with increased severity of erythema, erosion, and scabbing or crusting. The cosmetic outcomes were excellent.

For BCC, Dr. Ceilley said he prefers to use imiquimod prior to Mohs surgery, in conjunction with aggressive curettage and electrodesiccation. Treating for a few weeks preoperatively can reduce the defect, decrease the frequency of residual tumor, and improve cosmetic appearance.

"You can really define the lesions more carefully, minimizing the area of surgery you have to do," he said.

Evidence is mounting for the use of imiquimod in nodular BCC as well—especially in smaller, low-risk lesions or as adjunctive therapy. The original 2002 dosing study found a histologic clearance rate of up to 76%, with no significant difference between those who applied the medication daily for 12 or 16 weeks (Arch. Dermatol. 2002;138:1165-71), said Dr. Ceilley.

A more recent study found that while 70 of 90 patients (78%) had a complete clinical response, there was clinically visible tumor still present in 20 patients (22%). There was complete histopathologic clearance observed in 58 patients (64%), while residual tumor remained in 32 patients (36%). Efficacy was better in lesions smaller than 1 cm in diameter. The authors concluded that, since 17% of patients in the study with clinical clearance still had pathologic evidence of disease, excisional biopsy of the treated site is still indicated (J. Am. Acad. Dermatol. 2007;57:616-21).

Dr. Ceilley stated that he did not have any conflicts of interest to disclose.

'A number of studies have shown that imiquimod is up to 95% effective in clearing squamous cell carcinomas.' DR. CEILLEY