Dermatologists have been growing increasingly comfortable and confident with nonsurgical treatments for basal cell carcinomas, according to one expert.
"The future of small, superficial basal cell carcinoma treatment is probably going to be these topicals," Dr. Brown tells Dermatology Times.
When imiquimod was approved for superficial basal cell carcinoma (BCC) in the United States in 2004, it was approved for use on the trunk, neck and extremities, but many dermatologists are now using it on the face and with nodular BCCs, Dr. Brown says.
In 2006, Dr. Brown reported data from a post-marketing study conducted by 3M Pharmaceuticals that found that about 90 percent of 137 patients who were treated with imiquimod for BCC were free of any clinical recurrence for a full three years.
In a study conducted at 25 centers in Europe, sustained clinical clearance was seen in 87 percent of 182 patients at a five-year follow-up, Dr. Brown says. Most of the recurrences (14 of 18) occurred within the first two years after treatment.
Overall, the studies show that patients who use 5 percent imiquimod five times per week for six weeks have a likelihood of histologic clearance of between 70 percent and 80 percent, and that includes small nodular BCCs as well as superficial BCCs, he says.
While that is not quite as good as surgery - which has about a 5 percent recurrence rate - it is quite acceptable, and there are advantages. Patients should have a choice, he says.
There appears to be less pain associated with imiquimod than with surgery, and the cosmetic results tend to be much better, he says.
Moreover, imiquimod results are likely to continue improving, Dr. Brown says. It is now known that one needs to look for a brisk inflammatory response when one treats with imiquimod, and some studies have begun to investigate using imiquimod following curettage for nodular BCCs, achieving better results.
The same is true also of photodynamic therapy treatment, Dr. Brown says. Its BCC-clearance rates are not as good as the rates with surgery, but the cosmetic result tends to be much better, and techniques and treatment are improving steadily.
Photodynamic therapy has become much more convenient for patients. Whereas photodynamic therapy used to be performed with the photosensitizing agent applied the day before the light treatment, it is now clear that results are as good when the agent is applied just an hour or so before the light treatment.