Introduction

Journal of Drugs in Dermatology, Jan, 2008 by Brian Berman

Approximately 1 million cases of basal cell carcinoma (BCC) are expected to occur in the US this year. The current standard treatment of superficial BCC, curettage and desiccation (C & D) alone, is associated with scarring and recurrences. These disadvantages have led investigators to explore the concomitant use of immunotherapy for the treatment of BCC.

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Imiquimod (5% cream) is an immune response modifier that has been used alone for the treatment of BCC. When applied topically after C & D, imiquimod appears to reduce the likelihood of recurrence of BCC because imiquimod destroys residual BCC cells and may even induce long-term immune memory directed against tumor cells. Evidence has also been presented that imiquimod may also control excessive postsurgical scarring, a major concern following C & D.

My colleagues and I offer 4 papers in which we describe our experience with the use of imiquimod for the treatment of BCC. My introductory paper summarizes the rationale for combining imiquimod and surgical extirpation; Drs. Tillman and Carroll report their 36-month study of clearance rates, adverse effects, and cosmetic outcome associated with combining curettage and imiquimod; Dr. Rigel reports the results of his use of imiquimod after curettage without electrodessication for the treatment of nodular and superficial BCC; and Drs. Li and Li describe their exploration of imiquimod's ability to stimulate antiangiogenic cytokines, downregulate the expression of proangiogenic factors, upregulate the expression of endogenous inhibitors, and induce cell apoptosis.

Oncologists have long embraced the concept of combining surgery with other therapeutic modalities, including radiotherapy, hormone treatment, and immunotherapy. We hope you find the results of our studies useful in your search for an effective, well-tolerated combination treatment of BCC.

Brian Berman MD PhD

Departments of Dermatology and Medicine, University of Miami Miller School of Medicine Miami, FL

This Category 1 CME activity has been produced in accordance with recent Accreditation Council of Continuing Medical Education (ACCME) guidelines on Commercial Support. Author disclosures, if applicable, are provided at the end of each article. Any real or apparent conflict of interest has been addressed through a peer review process in order to ensure that this educational activity is unbiased and relevant to current physician educational needs.