Many people with basal cell carcinoma (BCC) in the head and neck region undergo Mohs micrographic surgery (MMS) to excise cancerous tissues and leave as much healthy tissue behind as possible. Imiquimod, an immune response modifier, is often administered as a topical cream in an effort to reduce the size, volume, and subclinical extensions of primary BCC lesions with the goal of reducing the number of stages needed.

A team of researchers in Portugal conducted a retrospective study to examine the effect of pretreatment with 5% imiquimod before MMS for nonsuperficial BCC in the head and neck region. Their findings were published in the British Journal of Dermatology.

The researchers analyzed 196 patients, 64 (33%) of whom were treated with imiquimod prior to MMS. They found that use of imiquimod resulted in a significant reduction in the number of stages necessary for tumor clearance.

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No tumor was present on histologic examination in the excised tissue of 36 patients (56%) in the imiquimod group. “Tumor clearance was noted after a single stage of Mohs surgery in 18 patients (28%),” they added. “Eight patients required a second stage (13%) and 2 patients a third stage (3%).”

By comparison, the patients who did not receive imiquimod pretreatment needed more stages of surgery. Of those 132 patients, 79 (60%) required one stage, 41 (31%) required 2 stages, 9 (7%) required 3 stages, one (1%) required 4 stages, and 2 patients (1%) required 5 stages.

In addition to a significantly reduced the number of stages, fewer complex closures were needed in those receiving imiquimod pretreatment.

The researchers noted that although imiquimod leaves open the possibility of an incomplete cure, its use is intended as a neoadjuvant modality before MMS, not as a definitive treatment.

The authors noted that the main limitation of their study was its retrospective design. Even so, they added, their work is the largest known series to evaluate neoadjuvant imiquimod prior to Mohs micrographic surgery for the treatment of nonsuperficial BCC in the head and neck region, with statistically significant results.


Quierós C, Silva L, Miroux Catarino A, Labareda J, Catorze G, Viana I. Topical imiquimod as neoadjuvant therapy before Mohs micrographic surgery for basal cell carcinoma in the head and neck region: findings from a large retrospective study. Br J Dermatol. Published May 16, 2021. doi:10.1111/bjd.20487