J Korean Ophthalmol Soc.  2015 Nov;56(11):1789-1793. 10.3341/jkos.2015.56.11.1789.

A Case Report of Eyebrow Basal Cell Carcinoma Successfully Treated with 5% Imiquimod Cream

• Kang BS
• Kim NJ
• Choung HK
• Khwarg SI

• KMID: 2214189
• DOI: http://doi.org/10.3341/jkos.2015.56.11.1789

Abstract

PURPOSE
Basal cell carcinoma is the most common malignant neoplasm of the skin. Periorbital basal cell carcinoma needs to be treated for cosmetic improvement and prevention of intraorbital invasion. Although surgical excision is a standard treatment, nonsurgical treatment using imiquimod cream, a topical immunomodulator, has been attempted. The authors report the first case of periorbital basal cell carcinoma successfully treated with imiquimod cream; to the best of our knowledge, similar cases have not been published to date in the Korean ophthalmology journals.
CASE SUMMARY
A 73-year-old female visited our hospital for treatment of a biopsy-proven basal cell carcinoma in the right eyebrow. A flat, elevated, 1 x 1 cm-sized mass having central indentation was observed in the centromedial area of the right eyebrow. She was treated with 5% imiquimod cream once daily at night, 5 days per week for 6 weeks. Eight weeks after the treatment with imiquimod cream was discontinued, the mass was flattened and the cilia began to grow on the mass site. Under the impression of a partial regression, an additional 4 weeks of application was recommended. The mass disappeared more and her eyebrow became more normal. At the final follow-up 31 months after treatment, her right eyebrow appeared normal.
CONCLUSIONS
Imiquimod cream may be a useful medication which can be used for complex periorbital basal cell carcinomas that are difficult to reconstruct after resection or surgical candidates with poor general condition.

Keyword

Imiquimod cream; Periorbital basal cell carcinoma

MeSH Terms

Aged
Carcinoma, Basal Cell*
Cilia
Eyebrows*
Female
Follow-Up Studies
Humans
Ophthalmology
Skin

Figure

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  Figure 1. External photography and the histopathological slides at her first visit. (A) An 10 × 10-mm-sized, flat, elevated lesion with minor central excavation is observed in the right centromedial eyebrow at her first visit. (B) The histopathological findings, HE stain, ×1.25 magnification: the invasive mass lesion is observed from the basal layer of the epidermis to the dermis. (C) The histo-pathological findings, HE stain, ×100 magnification: the clefts between stroma and tumor cell rest and necrotic lesion inside tumor cell are observed. (D) The histopathological findings, HE stain, ×400 magnification: the tumor cell apoptosis and mitosis are fre-quently observed. The tumor cell polymorphism is mildly observed. The basaloid cells that present thick granulated chromatins of nucleus surrounding thin pale cytoplasm with palisade arrangement of peripheral cells were observed. HE stain= Hematoxylin and eosin stain.

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  Figure 2. External photography after medication. (A) Post-medication photo: at 1 week after starting 5% Imiquimod cream. A focal redness is observed in the right eyebrow lesion, but there is no other complication or symptom. (B) Post-medication photo: at 8 weeks after 6 weeks’ 5% Imiquimod cream application and just before additional treatment. Her eyelid lesion is flattened and the cil-ia of the eyebrow begun to grow on the lesion site. However, the lesion still remains giving an impression of a partial regression. (C) Post-medication photo: at 4 week after additional 4 weeks’ 5% imiquimod cream. Her eyebrow lesion disappeared more. (D) At 6 months after the last application of 5% imiquimod cream. The eyebrow is like normal appearance. (E) At 9 months after last application. (F) At 31 months after last application (final follow up), the eyebrow looks normal.

Reference

References

1. Lomas A, Leonardi-Bee J, Bath-Hextall F. A systematic review of worldwide incidence of nonmelanoma skin cancer. Br J Dermatol. 2012; 166:1069–80.

2. Chinem VP, Miot HA. Epidemiology of basal cell carcinoma. An Bras Dermatol. 2011; 86:292–305.

3. Kim HS, Cho EA, Bae JM. . Recent trend in the incidence of premalignant and malignant skin lesions in Korea between 1991 and 2006. J Korean Med Sci. 2010; 25:924–9.

4. Rubin AI, Chen EH, Ratner D. Basal-cell carcinoma. N Engl J Med. 2005; 353:2262–9.

5. Carneiro RC, de Macedo EM, Matayoshi S. Imiquimod 5% cream for the treatment of periocular basal cell carcinoma. Ophthal Plast Reconstr Surg. 2010; 26:100–2.

6. David CV, Nguyen H, Goldenberg G. Imiquimod: a review of off-label clinical applications. J Drugs Dermatol. 2011; 10:1300–6.

7. Beutner KR, Geisse JK, Helman D. . Therapeutic response of basal cell carcinoma to the immune response modifier imiquimod 5% cream. J Am Acad Dermatol. 1999; 41:1002–7.

8. Marks R, Gebauer K, Shumack S. . Imiquimod 5% cream in the treatment of superficial basal cell carcinoma: results of a multi-center 6-week dose-response trial. J Am Acad Dermatol. 2001; 44:807–13.

9. Shumack S, Gebauer K, Quirk C. . 5% imiquimod cream for the treatment of large superficial basal cell carcinoma. Arch Dermatol. 2004; 140:1286–7.

10. Geisse J, Caro I, Lindholm J. . Imiquimod 5% cream for the treatment of superficial basal cell carcinoma: results from two phase III, randomized, vehicle-controlled studies. J Am Acad Dermatol. 2004; 50:722–33.

11. Vanaclocha F, Daudén E, Badía X. . Cost-effectiveness of treat-ment of superficial basal cell carcinoma: surgical excision vs. imi-quimod 5% cream. Br J Dermatol. 2007; 156:769–71.