Combining CO2 Laser, Diclofenac, and Imiquimod to Treat Inoperable Basal Cell Carcinoma
Posted: Wednesday, November 3, 2021
According to findings from a small study published in the Journal of Cosmetic Dermatology, a novel treatment regimen combining CO2 laser, 3% diclofenac, and 5% imiquimod has demonstrated potential as an effective alternative to surgical excision in high-risk basal cell carcinoma. Mohamed El-Khalawany, MD, of Al-Azhar University, Cairo, and colleagues followed 14 patients with inoperable disease for this open-label, uncontrolled study.
“Surgical treatment with pathological evaluation is the standard treatment for basal cell carcinoma. However, several nonsurgical, either physically ablative or medical, treatments could be used in low-risk tumors or inoperable cases,” the authors commented. “Combining ablative ultrapulse CO2 laser, diclofenac sodium 3% gel, and imiquimod 5% cream helps in treatment of nodular basal cell carcinoma, even the large-sized inoperable ones.”
Of the 14 total participants, there were 11 men and 3 women. Ages ranged from 57 to 72 years, and the duration of disease ranged from 3 to 14 years. As for disease location, nine lesions were on the scalp (64.3%), four were on the face (28.6%), and one was on the trunk (7.1%). Six lesions showed an ulcerative surface, two presented with a fungating mass, two presented with atrophic plaque, three had a pigmented mass, and one showed annular plaque. All lesions were larger than 5 cm, and four patterns were present: nodular, infiltrating metatypical, and micronodular.
The treatment duration ranged between 20 and 24 weeks, with the majority of patients (71.4%) experiencing initial improvements between weeks 12 and 16. At the end of treatment, nine patients showed significant clinical improvement, whereas five had a mild to poor response. Additionally, better response was exhibited in patients with nodular-type lesions, the investigators noted.
Disease relapse was most common during the fifth to sixth month of the follow-up period. Patients responding poorly to treatment were shifted to alternate therapeutic modalities.
Disclosure: The study authors reported no conflicts of interest.
