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Cryosurgery during Imiquimod (Immunocryosurgery) for Periocular Basal Cell Carcinomas: An Efficacious Minimally
Georgios Gaitanis1, Chris D Kalogeropoulos, Ioannis D Bassukas
1Department of Skin and Venereal Diseases, School of Health Sciences, Faculty of Medicine, University of Ioannina, Ioannina, Greece.
Insights
Immunocryosurgery offers a feasible and effective treatment for periocular basal cell carcinomas (pBCC). This approach achieved an 81% sustained remission rate in a study of high-risk tumors.
Area of Science:
- Dermatology
- Oncology
- Surgical Innovation
Background:
- Periocular basal cell carcinomas (pBCC) present significant treatment challenges.
- Surgical excision is standard but can be complex for delicate facial areas.
Purpose of the Study:
- To evaluate the feasibility and efficacy of immunocryosurgery for treating pBCC.
- To assess long-term outcomes and remission rates for this treatment modality.
Main Methods:
- Retrospective analysis of patients treated with immunocryosurgery between 2008 and 2014.
- Immunocryosurgery involved cycles of imiquimod and cryosurgery.
- Included high-risk pBCC, including post-surgical relapses and metatypical histology.
Main Results:
- 16 patients with high-risk pBCC were treated, with a median tumor diameter of 15 mm.
- Overall efficacy was 87.5%, with 13 out of 16 patients (81%) achieving sustained clinical remission.
- Tumor size influenced treatment success; larger tumors (>40 mm) were less responsive.
Conclusions:
- Immunocryosurgery is a viable and effective alternative to surgical excision for most pBCC.
- The treatment demonstrates promising results for challenging, high-risk periocular tumors.
Background/Aim:
Periocular basal cell carcinomas (pBCC) remain a treatment challenge. Our aim was to retrospectively evaluate the feasibility and efficacy of immunocryosurgery for the treatment of pBCC.
Methods:
Immunocryosurgery is given in 5-week cycles of daily imiquimod, with cryosurgery on day 14. Patients treated between 1/1/2008 and 31/12/2014 were included in this study.
Results:
Immunocryosurgery was offered to 19 patients. Of these, 16 (i.e., 6 males and 10 females, average age 74.9 years, median tumor diameter 15 mm, range 5-60 mm), with 1 tumor each, were treated. Six tumors (37.5%) were relapses after surgery and 2 were of metatypical histology. All BCC were high risk for recurrence after treatment; 10 tumors had 2 risk factors for relapse, 5 had 3, and 1 had 4. The follow-up period ranged between 3 and 60 months (average 25.6 months). Of the 16 tumors treated, 14 (all with a diameter <40 mm) cleared with immunocryosurgery (total efficacy 87.5%); 7 out of 16 tumors (44%; all with a diameter ≤20 mm) cleared with 1 conventional 5-week immunocryosurgery treatment cycle. Seven additional tumors (including 2 with a diameter >20 mm) required intensified treatment schemes (of up to 10 weeks) for clearance. The 2 tumors that did not clear responded partially and were also the 2 largest ones (diameter 40 and 60 mm). Of the 14 cleared tumors, 2 relapsed during follow-up; 1 cleared with immunocryosurgery. At the last examination during follow-up, 13 out of 16 (81%) patients were in sustained clinical remission.
Conclusions:
For most pBCC, immunocryosurgery is a feasible and efficacious alternative to surgical excision.
