Topical skin creams are effective in treating superficial basal cell carcinoma (BCC), a common cancer worldwide with increasing frequency. Results from a 3-year, randomized, controlled clinical trial indicate that 2 topical creams are effective in most cases of primary, low-risk superficial BCC. These creams compared favorably to photodynamic therapy (PDT).1

More than 80% of all skin cancers are basal cell carcinoma, which arises from the small, round cells in the lower layer of the epidermis. More than 2 million people in the United States each year develop basal cell carcinoma. Although prognosis is excellent, treatment may invade surrounding tissues causing significant disfigurement.

Most types of basal cell carcinoma require surgery; however, superficial BCC can be treated with noninvasive therapies such as PDT, imiquimod cream, fluorouracil cream, electrodessication, or curettage.

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In this study, 601 patients with superficial BCC were randomized to receive 1 of 3 noninvasive treatments: methylaminolevulinate-PDT (n = 202), imiquimod cream (n = 198), or fluorouracil cream (n = 201).

“The main advantages of noninvasive treatments are good cosmetic outcome, preservation of surrounding tissue, and potential for home application of either creams,” explained Marieke Roozeboom, MD, PhD, a resident in the Department of Dermatology, Maastricht University Medical Center, the Netherlands, and first author of this study.

Before this study, a lack of randomized, controlled trials with long-term follow-up comparing the effectiveness of noninvasive treatments resulted in a lack of consensus in international superficial basal cell carcinoma guidelines as to the first choice of noninvasive therapy.

Approximately 80% of patients in the imiquimod treatment arm were tumor-free. In the fluorouracil treatment arm, 68% of patients were tumor-free, and in the PDT group, 58% of patients were tumor-free.

“Based on our findings, both imiquimod and fluorouracil are effective noninvasive treatments in most primary, low-risk superficial BCC, but the data provide no definite evidence for superiority of imiquimod to fluorouracil,” explained Roozeboom.

“Both creams have an equal cosmetic outcome and risk of local adverse events. Fluorouracil has the advantage of being less expensive than imiquimod. However, between 1- and 3-year follow-up, more recurrences were diagnosed in the fluorouracil group compared with the imiquimod group.”

These results also suggest assessing the needs of each patient. Factors such as age, adherence, and patient preference should be taken into account when choosing a treatment for an individual patient with superficial basal cell carcinoma. For example, PDT is preferred over imiquimod for superficial BCC on the lower extremities of an older patient, explained Roozeboom. “Our evidence indicates that a personalized treatment approach is necessary.”


1. Roozeboom MH, Arits AH, Mosterd K, et al. Three year follow-up results of photodynamic therapy versus imiquimod versus fluorouracil for treatment of superficial basal cell carcinoma: a single blind, noninferiority, randomized controlled trial [published online April 23, 2016]. J Invest Dermatol. doi:10.1016/j.jid.2016.03.043.