What topical cream is used to treat basal cell carcinoma?

From the Guidelines

Imiquimod 5% cream (Aldara) is the primary topical treatment for superficial basal cell carcinoma (BCC), applied five times per week for six weeks, as it has been shown to be effective in treating small superficial BCCs with a histological clearance rate of 82% 1.

Key Considerations

• The treatment works by stimulating the immune system to recognize and attack cancer cells, making it most effective for superficial BCCs smaller than 2 cm in diameter and located on the trunk, neck, or extremities.
• Patients should expect local skin reactions including redness, swelling, and crusting, which indicate the immune response is working.
• Fluorouracil 5% cream is an alternative option, applied twice daily for 3-12 weeks depending on response.

Treatment Outcomes

• Topical treatments are best suited for low-risk, superficial BCCs in patients who prefer to avoid surgery or have contraindications to surgical intervention.
• However, they have lower cure rates (70-90%) compared to surgical excision (95-99%), so regular follow-up is essential to monitor for recurrence 2.
• Topical treatments are not appropriate for aggressive BCC subtypes, recurrent tumors, or those in high-risk locations like the face.

Recent Guidelines

• The NCCN Guidelines for Basal Cell Skin Cancer recommend considering patient-, lesion-, and disease-specific factors when selecting treatment, and guidance on when to use radiation therapy, superficial therapies, and hedgehog pathway inhibitors 3.
• The American Academy of Dermatology guidelines recommend surgical excision with 4-mm clinical margins and histologic margin assessment for low-risk primary BCC, and Mohs micrographic surgery for high-risk BCC 4.

From the FDA Drug Label

1.2 Superficial Basal Cell Carcinoma Imiquimod Cream is indicated for the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2.0 cm, located on the trunk (excluding anogenital skin), neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured INDICATIONS AND USAGE: Fluorouracil Cream USP is recommended for the topical treatment of multiple actinic or solar keratoses. In the 5% strength, it is also useful in the treatment of superficial basal cell carcinomas when conventional methods are impractical, such as with multiple lesions or difficult treatment sites.

The topical creams used to treat basal cell carcinoma are:

• Imiquimod Cream 5
• Fluorouracil Cream 6 Key considerations:
• Imiquimod Cream is indicated for superficial basal cell carcinoma with a maximum tumor diameter of 2.0 cm, located on the trunk, neck, or extremities.
• Fluorouracil Cream is useful in the treatment of superficial basal cell carcinomas when conventional methods are impractical.

From the Research

Topical Cream for Basal Cell Carcinoma

• Imiquimod 5% cream is approved for the treatment of superficial basal cell carcinoma (BCC) 7, 8, 9, 10.
• The cream works by modifying the immune response and stimulating apoptosis in BCC cells 10.
• Studies have shown that imiquimod 5% cream is effective in treating superficial BCC, with initial clearance rates ranging from 75% to 90% 8, 9, 10.
• The recurrence rate of superficial BCC after treatment with imiquimod 5% cream has been reported to be around 10-20% 7, 9, 11.
• Imiquimod 5% cream has been compared to surgical excision in the treatment of low-risk basal cell carcinoma, and while it was found to be inferior, it may still be a useful treatment option for small, low-risk lesions 8.
• The cream is generally well-tolerated, with common side effects including itching, weeping, and local skin reactions 8, 10.
• Sequential treatment with topical methyl aminolevulinate photodynamic therapy and imiquimod 5% cream has also been shown to be effective in treating superficial BCC, with a low recurrence rate of 10% 11.