Treatment of Cutaneous Tumors with Topical 5% Imiquimod Cream

• Published in: Clinics (São Paulo, Brazil) Brazil), 2009-01, Vol.64 (10), p.961-966
• Main Authors: Alessi, Sabrina Sisto, Sanches, Jose Antonio, de Oliveira, Walmar Roncalli, Messina, Maria Cristina, de Almeida Pimentel, Eugenio Raul, Neto, Cyro Festa
• Format: Article
• Language: English
• Subjects: Adjuvants, Immunologic - administration & dosage; Adjuvants, Immunologic - adverse effects; Administration, Topical; Adolescent; Adult; Aged; Aged, 80 and over; Aminoquinolines - administration & dosage; Aminoquinolines - adverse effects; Antineoplastic Agents - administration & dosage; Antineoplastic Agents - adverse effects; Basal cell carcinoma; Brazil - epidemiology; Child; Clinical Sciences; Female; Humans; Imiquimod; Immunomodulator; Immunotherapy; Male; MEDICINE, GENERAL & INTERNAL; Middle Aged; Non-melanoma skin cancer; Recurrence; Retrospective Studies; Skin Neoplasms - classification; Skin Neoplasms - drug therapy; Skin Neoplasms - epidemiology; Young Adult
• ISSN: 1807-5932; 1980-5322; 1980-5322
• DOI: 10.1590/S1807-59322009001000005

There are various approaches to the treatment of cutaneous tumors; one of them is treatment with imiquimod, a synthetic toll-like receptor agonist with a low molecular weight that offers a topical, noninvasive, and non-surgical therapeutic option. The main objective of our study was to provide data on 89 patients who used a 5% imiquimod cream for the treatment of cutaneous tumors at the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas from 2003 to 2008. Here, we present our experience in the treatment of 123 cutaneous tumors of various types, including basal cell carcinoma (BCC), squamous cell carcinoma (SCC), Bowen’s disease, erythroplasia of Queyrat, Paget’s disease, and trichoepithelioma, with 5% imiquimod cream from 2003 to 2008 in the Cutaneous Oncology Group of the Dermatology Department of Hospital das Clinicas. Patients were divided into two separate groups according to their diagnosis and comorbidities; these comorbidities included epidermodysplasia verruciformis, xeroderma pigmentosum, albinism, basal cell nevus syndrome, Brooke-Spiegler syndrome, HIV, chronic lymphocytic leukemia, B-cell lymphoma, and kidney transplantation. Treatment duration, response to imiquimod, follow-up, recurrence, and local and systemic reactions associated with use of the drug were analyzed. Epidemiological data were obtained and cure rates were calculated. The ratio of women to men was 1.28:1, and the mean age was 63.1 years. Tumors were located mainly on the face, back, trunk, and legs. For patients with comorbidities, the overall cure rate was 38%. These specific patients demonstrated cure rates of 83.5% for superficial BCC and 50% for Bowen’s disease. Aggressive BCC and superficial and nodular BCC did not present a good response to treatment. Trichoepitheliomas and nodular BCC showed a partial response, and erythroplasia of Queyrat showed a complete response. For patients without comorbidities, the overall cure rate was 73%. For these patients, the cure rates were 85.7% for superficial and nodular BCC, 88% for superficial BCC, 57% for Bowen’s disease, 50% for nodular BCC, and 50% for aggressive BCC. One SCC lesion demonstrated a complete response, and tumors caused by Paget’s disease and erythroplasia of Queyrat presented a partial response. None of the tumors considered as clinically cured recurred. Thirty-seven lesions demonstrated no response to imiquimod. Having a cutaneous comorbidity, high-risk tumors such as mixed aggressive BC