• Written By: Michael G. Haas, MD
    Comprehensive Ophthalmology

    This study published in the October issue of the British Journal of Ophthalmology compared the efficacy, cosmesis and tolerability of imiquimod 5% cream and radiotherapy (RT) for periocular nodular basal cell carcinoma (BCC). The authors found that both of these nonsurgical treatments caused eyelid nodular basal cell carcinoma to go into remission for more than 24 months, the duration of the study. Cosmesis and functional results were better with imiquimod, while tolerability was higher with radiotherapy.

    I was not aware that either of these modalities were commonly used for BCC treatment. However, I would consider using imiquimod cream based on the study's results, which suggest that it is cosmetically and functionally superior to radiotherapy, although it can cause significant skin irritation. The only drawback is that during this study, biopsies were still performed of the lesions, so treatment was not completely nonsurgical.

    This prospective study randomized 27 patients with periocular nodular basal cell carcinoma to RT or imiquimod 5% cream once daily, five days a week for six weeks.

    All tumors showed histopathological remission within three months of beginning treatment, with sustained clinical remission documented in each patient after 24 months of follow-up. Patients rated the tolerability of imiquimod as moderate and of radiotherapy good. Nine patients given imiquimod reported discomfort when they blinked, but only two patients reported considerable conjunctival irritation during application of the cream. These patients were treated with a combination of tobramycin and dexamethasone drops applied directly to the eye to reduce inflammation and prevent infection.

    The authors say that although the main objective of treating BCC is complete tumor removal to prevent recurrence, most patients with BCC are of advanced age or have important associated pathologies that contraindicate surgery. In these patients, nonsurgical approaches may be a good option. Cure rates are lower than those achieved with Moh micrographic surgery or surgical extirpation, but these treatments achieve clinical remission in most tumors and often improve quality of life.

    The authors note that with the mean age of BCC diagnosis having declined in recent years, younger people are requesting treatments that provide good functional and cosmetic results. The cosmetic result was scored as excellent by all patients treated with imiquimod. Loss of eyelashes was reported for most of the patients treated with radiotherapy, although the patients scored the cosmetic result as good.