Surgery Versus 5% Imiquimod for Nodular and Superficial Basal Cell Carcinoma:

Dr Jonny Levy reflects on research published in the Journal of Investigative Dermatology

Medical practise is conducted in private and we are each entrusted to follow our ‘true North’.

It is, therefore, essential to have the evidence underpin what we do clinically and it feels good to have our practises confirmed as being correct from time-to-time.

This research fulfils that. It has limitations, certainly, including a small sample size and margins for BCCs that are possibly larger than we would sometimes realistically take. Also, we don’t generally use Aldara for nodular BCCs.

But the conclusions we can draw are that surgery is highly effective for BCC and that Aldara does have a place in our armamentarium.

I would strongly suggest that, in this context, we limit it to superficial BCCs, as indicated here.

I’d suspect that Aldara in the sBCC group vs. surgery would be a far closer-run outcome. Remember, though, that Aldara does have its side effects and a failure rate.

It is good practise to ensure your patients are progressing as planned and expected. It is reasonable to schedule a quick review of progress intermittently through the treatment cycle (which can be ‘double booked’ or ‘squeezed in’ as it should take only a minute-or-two).

Given the inevitable failure rate, a clinical review of the treatment site several months (usually 3 – 6) after completion of the Aldara course is very valuable.

On a slight tangent, remember that surgery also has a failure rate – even when margins are reported as clear. Clearly advise patients to return if any skin cancer symptoms reappear around the excision site.

As it relates to the above, pre-formatted surgical consent sheets + Aldara advice sheets are amongst others available on the SunDoctors intranet.