Imiquimod and fluorouracil emerge as effective weapons for treating superficial basal cell carcinomas

Basal cell carcinoma, a type of skin cancer, affects millions of people worldwide. While traditional treatment has been surgery and radiation, topical treatments in combination with surgery are showing more promise for patients with basal cell carcinoma.

Speaking at ACADEMY '05, the American Academy of Dermatology's summer scientific session in Chicago, dermatologist Roger I. Ceilley, M.D., clinical assistant professor of dermatology at the University of Iowa, Des Moines, Iowa, discussed how medical and surgical treatments can be combined to increase effectiveness.

"The traditional treatment for basal cell carcinoma generally consists of surgery to remove the lesion," Dr. Ceilley said. "However, new medical therapies, imiquimod and fluorouracil, commonly called 5FU, are emerging as effective weapons for treating superficial basal cell carcinomas in combination with surgery."

Imiquimod stimulates the immune system to release chemicals called cytokines, which fight viruses and destroy cancer cells. In a small double- blind study by Dr. James Spencer at Mount Sinai University of imiquimod use in 20 patients with superficial basal cell carcinoma, half were given imiquimod cream after surgery and half were given a placebo cream.

All patients were instructed to use the cream nightly for one month. After two months, the area where the tumor had been was biopsied. Ten percent of the group using imiquimod had a residual tumor, compared to thirty percent of the placebo group. The majority of the imiquimod users also had a better cosmetic appearance, with mostly flat and slightly pink appearance at the lesion site.

"Possible recurrence of the skin cancer is one risk of traditional treatment," said Dr. Ceilley. "This study showed promise for reducing that risk, but more research needs to be done."

5FU is a topical chemotherapy drug that affects the metabolism of cells and prevents them from growing. It also is used to treat breast, stomach, bowel and esophageal cancers. Although there is limited data on the use of 5FU for basal cell carcinoma, small studies have shown that it is an effective therapy and may work best with surgery.

"The risk of scarring is another drawback of surgery," Dr. Ceilley said. "If we can shrink the size of the tumor before removal, the surgery will be more efficient and will leave a smaller scar."

"Combining medical and surgical treatments for basal cell carcinoma may reduce the risk of scarring and possible recurrence. A dermatologist can determine the most effective treatment for each individual."