Combining treatments in the treatment of skin cancer may provide better outcomes than skin excision alone according to a story published in the September issue of Dermatology Times, “Skin cancer recurrence may be prevented with combo of surgery and adjuvant therapies“.
James M. Spencer, M.D., M.S., a New York City dermatologist and Associate Professor at Mt. Sinai School of Medicine in New York spoke at the January 2010 Orlando Dermatology Aesthetic and Clinical conference where he argued that “dermatologists tend to use only one skin cancer treatment, despite the fact that there are tried-and-true adjuvant therapies and emerging medical therapies, such as imiquimod cream.”
Patients’ desire for a small scar following skin cancer excision leads Dr. Spencer to consider the use of imiquimod cream before surgery. This is not performed to cure the cancer, but rather to shrink the tumor before the procedure.
There are only a few studies looking at outcomes of skin cancer surgery with and without prior treatment with imiquimod, and results are mixed. A 2004 study by Torres A et al published in Dermatologic Surgery reported that use of 5 percent imiquimod cream prior to Mohs surgery resulted in a smaller defect than with excision only of basal cell carcinoma. A more recent 2009 study published in Dermatologic Surgery found no statistically significant benefit in using imiquimod 5 percent cream as an adjunctive treatment of nodular, nasal basal cell carcinomas before Mohs surgery. However, the authors noted that a larger study might show a benefit.
Despite this potential concern and limited data showing effectiveness, Dr. Spencer says it is reasonable to consider imiquimod cream use prior to surgery for the bigger, trickier skin cancers.
Lentigo maligna, or melanoma in situ, has a local recurrence rate of 10 percent to 20 percent. “Imiquimod has been studied as an effective monotherapy for lentigo maligna. So, in my practice, I excise lentigo maligna and follow that with topical imiquimod”, says Dr. Spencer. “Do I have proof that is helping anybody? No. But I would argue that falls into the ‘Why not?’ category.”
“The worst that could happen is nothing; the best that could happen is that your recurrence rate would go down,” said Dr. Spencer.