Basal Cell Cancer – Aldara

January 4th, 2011

Aldara (Imiquimod) is a prescription cream that can be used for treatment of select Basal Cell Cancers and I prescribe Aldara in my The Woodlands dermatology and Conroe dermatology offices.  Aldara is FDA approved for the treatment of Superficial Basal Cell Cancers on the neck, trunk and extremities.   It is not FDA approved for Basal Cell Cancers of any other histological type or location.  Aldara is used for those Superficial Basal Cell Cancers in which surgery is not an option, as the cure rate for surgical removal is higher than treatment with Aldara.  Aldara is a white cream that is applied to the biopsy proven Superficial Basal Cell Cancer 5x/week for 6 weeks.  The plastic portion of a cotton tip applicator can be used to apply the medicine over the cancer and with a 1cm margin of normal skin around the cancer.  During the treatment course, the skin being treated should become very red and inflamed as Aldara stimulates the body’s immune system to enter the skin cancer site and “attack” the cancer.  Aldara binds to Toll Like Receptor 7 to initiate the inflammatory cascade.  However, 1 out of 7 patients do not have this receptor so Aldara does not work in these patients.  Thus, I schedule all patients being treated with Aldara to follow up in dermatology clinic 3-4 weeks after beginning treatment to ensure that Aldara in evoking the proper immune response.  If they are not reacting to Aldara, other treatment options are discussed.  Patients are then scheduled to follow up 2 months after they began Aldara to ensure that the cancer is clinically resolved.  Occasionally, surveillance biopsies are performed to confirm clearance of the cancer.