Mohamed El-Khalawany1,2, Wael M Saudi3, Eman Ahmed4, Alsadat Mosbeh1, Ahmed Sameh2, Mahmoud A Rageh1. 1. Department of Dermatology and Venereology, Al-Azhar University, Cairo, Egypt. 2. Department of Dermatology and Venereology, Egyptian Armed Forces College of Medicine (AFCM), Cairo, Egypt. 3. Department of Dermatology and Venereology, Misr University for Science and Technology, Cairo, Egypt. 4. Department of Dermatology, Andrology, Sexual Medicine and STDs, Helwan University, Cairo, Egypt.
Abstract
BACKGROUND: Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. AIM: To evaluate the efficacy of combining ablative CO2 laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high-risk and inoperable BCC. PATIENTS/ METHODS: The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2 laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. RESULTS: The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. CONCLUSION: This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.
BACKGROUND: Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High-risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. AIM: To evaluate the efficacy of combining ablative CO2 laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high-risk and inoperable BCC. PATIENTS/ METHODS: The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high-risk inoperable BCC. They received an ablative session of CO2 laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. RESULTS: The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. CONCLUSION: This combined regimen is a good alternative therapeutic modality in high-risk inoperable BCC especially the nodular pathologic pattern.
Authors: Mohamed El-Khalawany; Hussein M M Hassab-El-Naby; Ahmed Mustafa Mousa; Ahmed Sameh; Mahmoud A Rageh; Rasha Mahmoud Genedy; Aya Magdy Hosny; Marwa A Aboelmagd; Soha Aboeldahab Journal: J Cancer Res Clin Oncol Date: 2022-07-23 Impact factor: 4.322