Generic selectors
Exact matches only
Search in title
Search in content
Post Type Selectors
Filter by Categories
15th National Conference of the IAOMFP, Chennai, 2006
Abstracts from current literature
Acne in India: Guidelines for management - IAA Consensus Document
Art & Psychiatry
Association Activities
Association Notes
Award Article
Book Review
Brief Report
Case Analysis
Case Letter
Case Letters
Case Notes
Case Report
Case Reports
Clinical and Laboratory Investigations
Clinical Article
Clinical Studies
Clinical Study
Conference Oration
Conference Summary
Continuing Medical Education
Cosmetic Dermatology
Current Best Evidence
Current Issue
Current View
Derma Quest
Dermato Surgery
Dermatosurgery Specials
Dispensing Pearl
Do you know?
Drug Dialogues
Editor Speaks
Editorial Remarks
Editorial Report
Editorial Report - 2007
Editorial report for 2004-2005
Fourth All India Conference Programme
From Our Book Shelf
From the Desk of Chief Editor
Get Set for Net
Get set for the net
Guest Article
Guest Editorial
How I Manage?
IADVL Announcement
IADVL Announcements
IJDVL Awards
IJDVL Awards 2018
IJDVL Awards 2019
IJDVL Awards 2020
IJDVL International Awards 2018
Images in Clinical Practice
In Memorium
Inaugural Address
Knowledge From World Contemporaries
Leprosy Section
Letter in Response to Previous Publication
Letter to Editor
Letter to the Editor
Letter to the Editor - Case Letter
Letter to the Editor - Letter in Response to Published Article
Letter to the Editor - Observation Letter
Letter to the Editor - Study Letter
Letter to the Editor - Therapy Letter
Letter to the Editor: Articles in Response to Previously Published Articles
Letters in Response to Previous Publication
Letters to the Editor
Letters to the Editor - Letter in Response to Previously Published Articles
Letters to the Editor: Case Letters
Letters to the Editor: Letters in Response to Previously Published Articles
Medicolegal Window
Miscellaneous Letter
Net Case
Net case report
Net Image
Net Letter
Net Quiz
Net Study
New Preparations
News & Views
Observation Letter
Observation Letters
Original Article
Original Contributions
Pattern of Skin Diseases
Pediatric Dermatology
Pediatric Rounds
Presedential Address
Presidential Address
Presidents Remarks
Report of chief editor
Report of Hon : Treasurer IADVL
Report of Hon. General Secretary IADVL
Research Methdology
Research Methodology
Resident page
Resident's Page
Resident’s Page
Residents' Corner
Residents' Corner
Residents' Page
Review Article
Review Articles
Revision Corner
Self Assessment Programme
Seminar: Chronic Arsenicosis in India
Seminar: HIV Infection
Short Communication
Short Communications
Short Report
Special Article
Specialty Interface
Study Letter
Study Letters
Symposium - Contact Dermatitis
Symposium - Lasers
Symposium - Pediatric Dermatoses
Symposium - Psoriasis
Symposium - Vesicobullous Disorders
Symposium Aesthetic Surgery
Symposium Dermatopathology
Symposium-Hair Disorders
Symposium-Nails Part I
Symposium-Nails-Part II
Systematic Reviews and Meta-analyses
Systematic Reviews and Meta-analysis
Therapeutic Guideline-IADVL
Therapeutic Guidelines
Therapeutic Guidelines - IADVL
Therapy Letter
View Point
What’s new in Dermatology
View/Download PDF

Translate this page into:

Case Report
doi: 10.4103/0378-6323.27757
PMID: 17050935

Superficial basal cell carcinoma on face treated with 5% imiquimod cream

Amit Kumar Malhotra1 , Arika Bansal1 , Asit R Mridha2 , Binod K Khaitan1 , Kaushal K Verma1
1 Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi - 110 029, India
2 Department of Pathology, All India Institute of Medical Sciences, New Delhi - 110 029, India

Correspondence Address:
Kaushal K Verma
Department of Dermatology and Venereology, All India Institute of Medical Sciences, New Delhi - 110 029
How to cite this article:
Malhotra AK, Bansal A, Mridha AR, Khaitan BK, Verma KK. Superficial basal cell carcinoma on face treated with 5% imiquimod cream. Indian J Dermatol Venereol Leprol 2006;72:373-375
Copyright: (C)2006 Indian Journal of Dermatology, Venereology, and Leprology


Imiquimod, an immune response modifier, is known to possess both anti-viral and anti-tumor effect. We report our experience of treating a large superficial spreading basal cell carcinoma with 5% imiquimod cream. A 65-year-old male had an asymptomatic, hyperpigmented, slowly progressive, indurated, 3 x 4 cm plaque on the left cheek for two months. Biopsy from the lesion showed features of basal cell carcinoma. The patient was treated with imiquimod 5% cream, topically three times a week for six months with complete resolution of the lesion and without any side-effects. There was no clinical or histological recurrence after three months of stopping the treatment.
Keywords: Basal cell carcinoma, Imiquimod, Treatment
Posttreatment photomicrograph 3 months after discontinuation of the treatment showing disappearance of basaloid cells (H and E, 400x)
Posttreatment photomicrograph 3 months after discontinuation of the treatment showing disappearance of basaloid cells (H and E, 400x)
Posttreatment photograph
Posttreatment photograph
Pretreatment photomicrograph showing a nest of basaloid cells with peripheral palisading in the dermis (H and E, 400x)
Pretreatment photomicrograph showing a nest of basaloid cells with peripheral palisading in the dermis (H and E, 400x)
Pretreatment photograph
Pretreatment photograph


Basal cell carcinoma (BCC) is the most common malignant tumor of the skin.[1] The nodular or nodulo-ulcerative and superficial types comprise nearly 80% of all BCCs and are less aggressive.[1] The aim of the treatment in BCC is to achieve histologically confirmed cure. For large lesions at critical sites such as the face, where tissue conservation is important, Moh′s micrographic surgery is ideal, but the technique is not readily available. Surgical excision of a large lesion with 2-4 mm free margin may leave an aesthetically unpleasant scar.

Topical imiquimod, an immune response modifier has been found to be effective in superficial and nodular subtypes of BCC with clearance rates of up to 100%.[2],[3],[4] Successful treatment of a large superficial spreading BCC on the face with 5% imiquimod cream is reported here. To our knowledge, it is the first report of use of imiquimod in basal cell carcinoma from India.

Case report

A 65-year-old male presented with a single asymptomatic, hyperpigmented plaque on the left cheek since two months. The lesion started as a small plaque and gradually increased in size. There was no history of exposure to radiation other than routine sun-exposure. There were no systemic symptoms. The past and the personal history were noncontributory. Cutaneous examination showed an erythematous, indurated, irregular plaque of size 3 x 4 cm with raised pigmented margins [Figure - 1]. There was a small area of atrophy and depigmentation within the plaque near the edge. There was no ulceration or regional lymphadenopathy. Systemic examination did not reveal any abnormality. A clinical diagnosis of superficial spreading basal cell carcinoma was made and a biopsy from the edge of the plaque showed multiple nests of basaloid cells with peripheral palisading in the papillary dermis in continuity with the overlying epithelium [Figure - 2].

The patient was treated with 5% imiquimod cream applied three times a week on alternate days. After three applications there was intense erythema followed a week later by scaling. The patient had no discomfort and the treatment was continued further. After 12 weeks (36 applications) there was near-complete resolution of erythema, pigmentation and raised margins. The plaque was replaced with a mildly atrophic scar merging with the surrounding normal-looking skin [Figure - 3]. The treatment was continued for another three months. A biopsy done three months after discontinuation of the treatment showed disappearance of basaloid cells with only pigment incontinence and fibrosis in the superficial dermis [Figure - 4]. There was no evidence of residual tumor on multiple sections.


Imiquimod, an imidazoquinolone amine, has both anti-viral and anti-tumor activity. It enhances both innate and acquired immunity.[5] It has been approved for the treatment of anogenital warts and actinic keratosis by US FDA.[5],[6] It has been effectively used for nongenital warts, molluscum contagiosum, basal cell carcinoma, squamous cell carcinoma in situ, malignant melanoma, keratoacanthoma, prevention of keloids after surgery, cutaneous T-cell lymphoma, cutaneous extramammary Paget′s disease and morphea.[5],[6],[7] In some case studies it has been shown to be effective even in infantile hemangiomas, porokeratosis of Mibelli, cutaneous leishmaniasis, tattoo removal and eccrine poroma.[8],[9]

The precise mechanism of the anti-tumor effect of imiquimod in BCC is not known. It has been postulated that ultraviolet radiation induces mutations in the tumor-suppressor genes and alters the immuno-surveillance, so that tumor cells escape from cytotoxic T cells and apoptosis.[1] Th-2 cytokines, that downregulate tumor surveillance, are raised in BCC.[1],[5] Imiquimod acts on toll-like receptor-7 (TLR-7) present on dendritic cells, macrophages and monocytes and induces expression of interferons, Th-1 cytokines (IL-1, IL-6, IL-10 and IL-12), tumor necrosis factor-a and G-CSF, thereby counteracting Th2 cytokines and promoting tumor surveillance.[1],[5] It also enhances the activity of natural killer cells and epidermal Langerhans′ cells. The tumor regression is achieved probably by induction of Fas receptors on the tumor cells resulting in their apoptosis.[10]

Imiquimod as a monotherapy has shown unequivocal cure rates ranging from 60-100% with twice-daily, once-daily and thrice-weekly regimens for both superficial and nodular BCC.[4] The cure rate approaches 100% as the frequency of daily applications is increased.[2],[3],[4] In our case we preferred to start the therapy with low-frequency applications due to the uncertainty about the local and systemic side-effects in Indian patients. Although imiquimod therapy is considered safe, both local and systemic side-effects have been reported.[2],[3],[4] Local side-effects include erythema, itching, pain, vesiculation, ulceration and hypopigmentation, which occur more frequently with twice-daily applications. Systemic side-effects are usually mild, which include headache, fever, malaise, arthralgia, nausea and diarrhea. Our patient developed only erythema, probably due to cytokine induction.

It is also easy to monitor the response to therapy clinically, since with imiquimod, histological cure has been found in all cases where the clinical cure was considered.[4] In addition, histological cure was confirmed in up to one-third of cases when clinically the cure was still in doubt.[4] Moreover, imiquimod therapy leaves behind excellent healed site aesthetically, as seen in our case.

We therefore conclude that imiquimod may be used as a noninvasive, patient-administered, topically effective medical therapy for the management of commonly encountered less aggressive forms of large BCCs, especially in a setting where surgical approach is not amenable. However, long-term follow-up of a larger number of cases is needed to establish its role in the management of such patients.

Salasche S. Imiquimod 5% cream: A new treatment option for basal cell carcinoma. Int J Dermatol 2002;41:16-20.
[Google Scholar]
Beutner KR, Geisse JK, Helman D, Fox TL, Ginkel A, Owens ML. Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5% cream. J Am Acad Dermatol 1999;41:1002-7.
[Google Scholar]
Sterry W, Ruzicka T, Herrera E, Takwale A, Bichel J, Andres K, et al . Imiquimod 5% cream for the treatment of superficial and nodular basal cell carcinoma: Randomized studies comparing low-frequency dosing with and without occlusion. Br J Dermatol 2002;147:1227-36.
[Google Scholar]
Geisse JK, Rich P, Pandya A, Gross K, Andres K, Ginkel A, et al . Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: A double-blind, randomized, vehicle-controlled study. J Am Acad Dermatol 2002;47:390-8.
[Google Scholar]
Tyring S, Conant M, Marini M, van der Meijden W, Washenik K. Imiquimod; An international update on therapeutic uses in dermatology. Int J Dermatol 2002;41:810-6.
[Google Scholar]
Navi D, Huntley A. Imiquimod 5 percent cream and the treatment of cutaneous malignancy. Dermatol Online J 2004;10:4.
[Google Scholar]
Dytoc M, Ting PT, Man J, Sawyer D, Fiorillo L. First case series on the use of imiquimod for morphea. Br J Dermatol 2005;153:815-20.
[Google Scholar]
Berman B, Poochareon VN, Villa AM. Novel dermatologic uses of the immune response modifier imiquimod 5% cream. Skin Therapy Lett 2002;7:1-6.
[Google Scholar]
Jo JH, Chin HW, Kim MB, Oh CK, Jang HS, Kwon KS. A case of eccrine poroma treated with 5% imiquimod cream. J Dermatol 2005;32:691-3.
[Google Scholar]
Urosevic M, Maier T, Benninghoff B, Slade H, Burg G, Dummer R. Mechanisms underlying imiquimod-induced regression of basal cell carcinoma in vivo . Arch Dermatol 2003;139: 1325-32.
[Google Scholar]

Fulltext Views

PDF downloads
Show Sections