Reversible Severe Reaction to Imiquimod During Treatment of Eyelid Nodular Basal Cell Carcinomas

Two patients affected by eyelid nodular basal cell carcinomas (BCC) were treated topically with 5% imiquimod. The first case experienced pain, extensive erythema and crusting, retractile medial ectropion and conjuctival mucous secretions during the second week of treatment. These effects improved progressively until the sixth week. Complete clearance of the BCC was also observed. The second case presented during the third week of treatment with pain and a wide crust similar to a third-degree burn. Two months later, complete clearance of the BCC was observed. The total absence of scars in the eyelid skin and absence of cicatricial ectropion were remarkable. Severe reactions may occur during treatment with topical imiquimod for nodular BCC of the eyelids. However, excellent cosmetic results remain after cessation of treatment.