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DOI: 10.1111/j.1468-3083.2011.03977.x

ORIGINAL ARTICLE

Effectiveness and satisfaction with imiquimod for the

treatment of superficial basal cell carcinoma in daily
dermatological practice
E. Dauden,* on behalf of the BASALE Study Group1
Service of Dermatology, Hospital Universitario de la Princesa, Madrid, Spain
*Correspondence: E. Dauden. E-mail: estebandauden@medynet.com

Abstract
Background The use of imiquimod for the treatment of superficial basal cell carcinoma (sBCC) in actual conditions
of the daily practice has been poorly studied.
Objective A prospective, observational and multicentre study was designed to gather information on the
effectiveness and safety of imiquimod therapy in patients with sBCC in daily practice. Patients satisfaction with
imiquimod was also assessed.
Methods A total of 370 adult patients with sBCC were included in the study. Patients were treated with imiquimod
5% cream five times per week for 6 weeks. A maximum of three lesions per patient were treated. Patients were
requested to complete diary cards to register treatment-related events and had a final visit within 16 weeks after the
end of treatment.
Results Target sBCCs included 471 tumours, with a mean (SD) 1.3 (0.6) lesions per patient. Most sBCC were
primary tumours (92.6%). Tumours were clinically diagnosed in 63.2% of cases and histologically confirmed in
36.8%. Previous sBCC had occurred in 42% of the patients. The mean number of daily applications of imiquimod
was 1.0 (0.1) for a mean of 4.9 (0.5) days per week. The mean duration of treatment was 6.0 (1.0) weeks. In 13
patients (14 target sBCCs), rest periods were indicated with a mean of 5.0 (2.8) rest days. The clearance rate was
83.2%. Clearance rate was independent of the tumour size. Local skin reactions (mostly erythema) occurred in 85%
of cases (mild 37%, moderate 39% and severe 24%). Nine patients discontinued imiquimod treatment because of
severity of application site reactions. Most patients (82.1%) were very satisfied or satisfied with imiquimod.
Conclusions The present data from a prospective study carried out in a community setting adds evidence of the
usefulness and favourable clinical profile of imiquimod 5% cream when administered for treating sBCC.
Received: 31 January 2010; Accepted: 10 January 2011

Conflicts of interest
Dr. Esteban Dauden has the following conflict of interests: Advisory Board member, consultant, grants, research
support, participation in clinical trials, honorarium for speaking, research support, with the following pharmaceutical
companies: Abbott, Astellas, Biogen, Centocor Ortho Biotech Inc., Galderma, Glaxo, Janssen-Cilag, Leo Pharma,
Merck-Serono, Novartis, Pfizer, Schering-Plough, Stiefel, Wyeth Pharmaceuticals, 3M.

Funding sources
This study was sponsored by MEDA Pharma, Madrid, Spain.

Introduction
Basal cell carcinoma (BCC) is the most common skin cancer in
fair skinned populations and the incidence of BCC continues to
rise by approximately 10% per year.1 Although mortality is low,
this malignancy causes considerable morbidity and places a huge
burden on healthcare services worldwide.2 Superficial BCC (sBCC)
1

See Appendix.

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comprises up to 25% of all histological subtypes and appears as

erythematous, slightly scaly and well-defined patches mostly found
on the trunk and limbs. In highly sun-exposed populations,
lesions are also common on the face.3
There are a variety of treatment options for BCC, including
surgery and different destructive procedures, photodynamic therapy and other non-invasive modalities, such as topical 5-fluorouracil and the immune-response modifier imiquimod. Imiquimod

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Imiquimod for superficial basal cell carcinoma

available as a 5% cream is approved in different countries for use

in sBCC using a regimen of once daily, five times per week for
6 weeks. Imiquimod acts as a Toll-like receptor (TLR)-7 agonist
stimulating the dendritic cells in the epidermis and dermis to
release interferon a and other cytokines. It is thought to exert its
anti-tumour effect via modification of the innate and cell-mediated
immune response pathway with activity against tumour cells
resulting in apoptosis.4,5
Data from clinical trials with imiquimod 5% cream for the
treatment of sBCC have shown encouraging results with shortterm clearance rates (clinical and histological combined) in the
range between 73% and 90%.615 In two identical randomized,
double-blind vehicle-controlled phase III studies, subjects with
one sBCC were dosed with imiquimod or vehicle cream once daily
5 or 7 times per week for 6 weeks. The difference in clearance rates
between the two imiquimod dosing groups was not statistically
significant and according to these results, the five times per week
regimen was recommended.9 On the other hand, in large phase III
studies the histological clearance rates have been consistently
found to be higher than the clinically observed clearance rate.9,10
In a 5-year long-term follow-up study carried out in Europe, the
estimate of overall treatment success for all treated patients at the
end of follow-up was 78% (81% if histological data were considered).16 Application site reactions, which are the most common
adverse effects, are seen in up to 87% of patients treated for sBCCs
with imiquimod applied five times per week for 6 weeks.17 The
most common local site reactions are erythema, oedema, induration, erosion, scaling, crusting, pruritus and burning sensations. In
some patients, the severity of application site reaction warrants
transient discontinuation of treatment. Rest periods, however, do
not affect the efficacy of treatment.
Imiquimod trials and several published clinical series provide
evidence of the benefits of imiquimod therapy for sBCC. However,
there is limited data on the use of imiquimod 5% cream in routine
daily practice. To our knowledge, no previous study carried out in
a community setting in a large sample of patients with sBCC treated with imiquimod has been reported. Therefore, a nationwide
prospective multicentre study was conducted with two aims: (i) to
assess the effectiveness, safety and tolerability of treatment with
imiquimod 5% cream for sBCC in conditions of daily practice,
and (ii) to determine patients satisfaction with topical imiquimod
application.

Methods
Study design

A prospective, observational and multicentre study was designed

to assess the effectiveness, safety and tolerability of imiquimod 5%
cream for the treatment of patients with sBCC in conditions of
daily dermatological practice. Secondary objectives of the study
were the assessment of the patients satisfaction with topical imiquimod and compliance with treatment as well as to assess whether

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1305

dermatologists prescribed imiquimod in accordance with the

product technical specifications. The study was carried out at the
outpatient clinics of the services of dermatology of different hospitals throughout Spain in the routine clinical setting. The participating centres belonged to the public Spanish National Health
Care System. A total of 92 dermatologists from 32 hospitals agreed
to participate voluntarily in the study. Ten patients per site had to
be enrolled over a 3-month period.
The study protocol was approved by the ethics committee of
the participating centres and the local agencies of the Autonomous
Communities. All patients were fully informed about the characteristics of treatment with imiquimod 5% cream and gave written
informed consent.
Patients

Between 1st January 2006 and 31st March 2007, all consecutive
patients of both sexes aged 18 years or older, with histologically
proven sBCC or lesions clinically consistent with sBCC in which
treatment with imiquimod 5% cream was indicated by the dermatologist in charge according to the product technical specifications
were eligible, provided that they gave written informed consent
and were able to understand and follow the study procedures.
Patients with other subtypes of BCC were excluded as were those
in whom the use of imiquimod was contraindicated according to
the product technical specifications. Pregnant women and nursing
mothers were also excluded.
Study procedures and data collection

The study was based on a first (baseline) visit, a variable number of

follow-up visits during and after treatment with topical imiquimod
scheduled by the participating dermatologist according to his her
practice, and a final visit at 3 months to assess the effectiveness of
treatment within a maximum interval of 16 weeks after the end of
treatment. Baseline and final visits were mandatory by study protocol. The baseline visit was the initiation of treatment with imiquimod 5% cream (12.5 mg imiquimod in monodose sachets of
250 mg cream) (Aldara, 3M Espana, Madrid, Spain). The recommended dosing frequency was once daily five times per week
(5 times per week) for 6 weeks prior to normal sleeping hours. The
cream was to remain on the skin for at least 8 h without occlusion,
and then removed with mild soap and water. Dermatologists could
prescribe treatment-free rest periods at their own decision. A maximum of three sBCCs per patient were selected for treatment.
At the first visit the following variables were recorded: demographics, underlying chronic diseases and use of concomitant medications, previous sBCC (site and treatment), and characteristics of
the target lesion(s), such as date and diagnostic method, site, size,
primary or recurrent sBCC, previous treatment, and date of starting imiquimod. Patients were given a diary card, one per sBCC to
be treated, to register all days in which imiquimod was applied,
missed doses and rest days (according to the prescribed regimen or
as a result of local site reactions). Clinical evolution of lesions, local

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Dauden

1306

skin reactions and their treatment, rest periods, adverse events

(AEs) and compliance with treatment were recorded in the followup visits. At the final visit, effectiveness of imiquimod 5% cream
and patients satisfaction with treatment were also evaluated.
For each lesion, effectiveness of treatment was assessed in terms
of presence or absence of clearance defined according to clinical or
histological criteria used in the routine clinical practice by the participating dermatologist. Biopsy was only carried out if this procedure was indicated according to the standard clinical practice of
each centre. A 7-point Likert scale was used to assess patients satisfaction, which included the following categories: extremely satisfied, satisfied, somewhat satisfied, neither satisfied nor dissatisfied,
somewhat dissatisfied, dissatisfied and extremely dissatisfied. Safety
was assessed by recording the AEs observed by the investigator or
reported by the patient either spontaneously or answering to open
questions. Details on the seriousness, severity, action taken, outcome and relationship to imiquimod treatment were also
recorded. With regard to tolerability, frequency and severity of
local skin reactions were evaluated. Compliance with treatment
was assessed by checking diary cards.

Subjects screened, n = 373

sBCC diagnosis not confirmed, n = 2
Missed baseline data, n = 1

Enrolled, n = 370
Withdrew in treatment, n = 18
Local skin reactions, n = 9
Patients decision, n = 6
Lack of improvement, n = 1
Good response, n = 1
Concurrent herpes zoster, n = 1
Withdrew in follow-up, n = 3

Completed the study, n = 349

Figure 1 Subject disposition.

Table 1 Baseline characteristics and location of target superficial basal cell carcinoma (sBCC)

Statistical analysis

The Statistical Package for Social Sciences (SPSS Inc., Chicago, IL,
USA) (version 15.0) for Windows was used for the analysis of
data. Double data entry was carried out with a subsequent validation to guarantee the quality and consistency of the data. Continuous variables are expressed as mean and standard deviation (SD)
and qualitative variables are described as frequencies and percentages. The chi-squared test or the Fishers exact tests were used for
the comparison of categorical variables and the Students t-test for
continuous variables. Statistical significance was set at P < 0.05.

Data

n (%)

Total patients

370

Gender
Male

200

Female

170

Age, years, mean (SD)

Concurrent malignancy or immunosuppressive disorder
History of previous sBCC

34 (9.2)
154 (41.6)

Treatment of previous sBCC

Surgery

Results

Electrocoagulation

A total of 373 eligible patients were recruited but three patients

were excluded (the diagnosis of sBCC was not confirmed in two
and missing baseline data in one patient). Twenty-one patients
discontinued the study, 18 during the treatment period and three
during the post-treatment period. Subject disposition during the
study is shown in Fig. 1.
The study population included 370 patients, 200 men and 170
women, with a mean (SD) age of 68.4 (13.2) years. The total number of sBCCs was 471, with a mean of 1.3 (0.6) target lesions per
patient. Target sBCCs were diagnosed clinically in 63.2% of cases
and histologically confirmed in 36.8%. Most sBCCs were primary
tumours (92.6%), recurrent tumours occurred in 35 (7.4%) cases.
Tumours were located on the face in 34.8% of cases, in the trunk
in 29.3% and in the extremities in 24.2%. Concomitant malignancy or immunosuppressive disorders were present in 34 (9.2%)
patients. History of previous sBCC was recorded in 154 (41.6%)
patients, 14 of which had been treated with imiquimod. The baseline characteristics of patients and site of target tumours are shown
in Table 1. The mean (SD) size of target sBCC was 1.6 (2.9) cm2.

Curettage

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68.4 (13.2)

Cryosurgery
5-FU
Imiquimod
Radiotherapy
Target tumours

124 (80.5)
10 (6.5)
3 (1.9)
10 (6.5)
8 (5.2)
14 (9.1)
8 (5.2)
471

Location
Face

164 (34.8)

Ear and external auditory canal

11 (2.3)

Neck and scalp

41 (8.7)

Trunk

138 (29.3)

Upper extremity

92 (19.5)

Lower extremity

22 (4.7)

Not specified
Size, cm2, mean (SD)

3 (0.6)
1.6 (2.9)

sBCC, superficial basal cell carcinoma.

The mean number of daily applications of imiquimod 5%

cream was 1.0 (0.1) for a mean of 4.9 (0.5) days per week. The
mean duration of treatment was 6.0 (1.0) weeks. Deviations from

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Imiquimod for superficial basal cell carcinoma

100

1307

Table 2 Clearance rates according to site of lesions in 446

evaluable tumours at the final visit

Clearance
No clearance

90
80

Site of lesion

Clearance, n (%)

Face, n = 156

131 (84)

70

Ear and external auditory canal, n = 11

60

Neck and scalp, n = 37

50

Trunk, n = 130

40
30

8 (72.7)
32 (86.5)
109 (83.8)

Upper extremity, n = 87

73 (83.9)

Lower extremity, n = 22

16 (72.7)

Not specified, n = 3

2 (66.7)

20
10
0

<0.5

0.5 to 1
1 to 2
Target tumour size (cm2)

>2

Figure 2 Clearance rates of target superficial basal cell carcinomas (sBCCs) (clinical and histological combined) in relation to
tumour size.

the product technical specifications in the number of applications

per week were recorded in 39 sBCCs and in the number of treatment weeks in 90. In 13 patients (14 target sBCCs), rest periods
were indicated by the dermatologist in charge, with a mean of 5.0
(2.8) rest days. The mean number of follow-up visits including the
final visit was 2.9 (0.8).
A total 446 target tumours from 346 patients were evaluable at
the final visit. The clearance rate was 83.2% (371 446). In the large
majority of lesions, the final outcome was defined clinically, with a
clinical clearance rate of 94.9% (352 371). In only 19 cases, biopsies were also performed to confirm histological clearance. The
clearance rate was similar in primary tumours (83.1%) than in
recurrent lesions (83.9%) (P = 0.92). On the other hand, clearance
rate was independent of the tumour size. Although tumours in
which clearance was obtained showed a lower size [mean 1.5 (2.6)
cm2) than those in which clearance was not obtained [mean 1.9
(4.1) cm2], differences were not statistically significant (P = 0.20).
Clearance rates were higher in tumours 2 cm2 than in larger
tumours (>2 cm2) but differences were not significant (Fig. 2).
As shown in Table 2, clearance rates were higher in tumours
located on the face (84%) than in tumours located on the ear and
external auditory canal (72.7%) or the lower extremities (72.7%)
but statistically significant differences according to site were not
observed (P = 0.70). In addition, clearance rates were also similar
in patients without malignancy or immunosuppressive disease
(84.3%) than in those with malignancy or immunosuppressive
disorder (73.8%) (P = 0.13).
During the treatment period, AEs (excluding local reactions)
were reported by four patients, with an incidence of 1.1%. Adverse
events included headache in two patients, influenza-like symptoms
in one, and irritative dermatitis in one. The intensity of AEs was
mild in three patients and moderate in one but no patient discontinued imiquimoid treatment because of an AE.

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Table 3 Local skin reactions in 471 target superficial basal cell

carcinoma (sBCC) treated with imiquimod 5% cream
Type of reaction

Total
Mild

Moderate

Erythema

364 (77.3)

141 (38.7)

158 (43.4)

65 (17.9)

Crusting

179 (38.0)

63 (35.2)

69 (38.5)

47 (26.3)

Oedema

153 (32.5)

58 (37.9)

77 (50.3)

18 (11.8)

Erosion

128 (27.2)

59 (46.1)

44 (34.4)

25 (19.5)

Scaling

105 (22.3)

70 (66.7)

27 (25.7)

8 (7.6)

Vesicles

67 (14.2)

26 (38.8)

30 (44.8)

11 (16.4)

Itching

47 (10)

12 (25.5)

26 (55.3)

9 (19.1)

Bleeding

29 (6.2)

14 (48.3)

10 (35.7)

5 (17.9)

Pain

22 (4.7)

7 (31.8)

13 (59.1)

2 (9.1)

Burning

Intensity
Severe

30 (6.4)

7 (23.3)

15 (50)

8 (26.7)

Hypopigmentation

102 (21.7)

81 (79.4)

20 (19.6)

1 (1.0)

Hyperpigmentation

26 (5.5)

22 (84.6)

3 (15.4)

1 (3.8)

Percentages in parenthesis.

Application site reactions were observed in 401 target sBCC

(85.1%) (mild 36.7%, moderate 38.9% and severe 24.4%). Type,
frequency and intensity of local site reactions are shown in
Table 3. Erythema, crusting, oedema, erosion and scaling were the
most common application site reactions. Local infection was suspected in 15 cases (4.2%), 11 of which were treated with fusidic
acid. Post-treatment hypopigmentation was observed in 22% of
cases. Nine patients discontinued imiquimod during the treatment
period because of severity of local site reactions. There were no
significant differences in the percentage of local site reactions
between target tumours with or without rest periods (100% vs.
93.5%, P = 0.8). However, the occurrence of severe reactions was
significantly higher in the group of lesions with rest periods (50%)
than in those without rest periods (28.1%) (P = 0.03) given that
rest periods were mostly indicated in patients with more (or more
severe) local site reaction. Treatment for application site reactions
was prescribed in 30.2% of cases and included topical antibiotics
in 46.7%, corticosteroids in 20.6%, combined corticosteroids and
antibiotics in 21.5% and antiseptics in 13.1%.
Most patients (82.1%) were extremely satisfied or satisfied with
imiquimod therapy; only 4.3% of patients manifested to be dissatisfied or extremely dissatisfied (Fig. 3).

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Dauden

1308

Extremely satisfied
Satisfied
Somewhat satisfied
Neither satisfied nor dissatisfied
Somewhat dissatisfied
Dissatisfied
Extremely dissatisfied

10

20

30

40

50

Figure 3 Patients satisfaction with imiquimod treatment of

superficial basal cell carcinoma (sBCC) (data in percentages).

At the final visit, diary cards were collected in 206 cases

(46.2%). Compliance with treatment was very high, with application of topical imiquimod for a mean of 31.1 (16.7) days and 7.7
(9.3) days off. The mean number of missed doses was 0.3 (0.8)
days. Compliance >80% with imiquimod regimen was observed
in 99% of the patients.

Discussion
The therapeutic potential of imiquimod in clinical practice has
been recognized for the past decade. Following an approved indication for the treatment of external genital warts, imiquimod 5%
topical cream has received further approval for treating actinic
keratosis and small sBCC in adults. Currently, imiquimod 5% topical cream is a widely studied and characterized TLR-7 agonist
available in the clinical milieu.18,19 The present prospective and
multicentre study carried out in a large sample of patients with
sBCC provides data on the effectiveness and safety of imiquimod
topical therapy in real life conditions. To our knowledge, no previous prospective study in a large sample of patients with sBCC treated with imiquimod in actual conditions of the daily practice has
been reported. Therefore, this study adds descriptive information
on the use of this immune response modulator in patients seeking
medical care at dermatological clinics in Spain. The present findings may be useful to gather postapproval safety and efficacy data.
In this clinical series of 370 patients, with a total of 471 target
sBCCs treated with imiquimod 5% cream, a clearance rate of
83.2% was obtained. In the majority of patients, the final outcome
was defined clinically only (clinical clearance rate of 94.9%), histologically in 3.2% of cases and clinically and histologically in 1.9%
of cases. The high clearance rate confirms the efficacy of imiquimod for treating sBCC reported in clinical trials.6,8,9,14,16,20 The
fact that the final outcome was histologically defined in only 19
patients supports the dermatologists ability to clinically determine
that the tumour is gone at the end of treatment and that clinical
clearance is ultimately used in clinical practice. On the other hand,
the low rate of histological confirmation is related to the naturalistic design of the study. Because the study was carried out in daily
practice conditions, no indications regarding histological assessment of the final outcome were predefined, which is different than

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strict requirements imposed in phase III clinical trials. Moreover,

in accordance with the objective of the study to assess how dermatologist used imiquimod 5% cream for sBCC in their routine
practices, there were no restrictions regarding excluding patients
with recurrent lesions or concomitant malignancies or immunosuppression. All patients were visited at 3 months but visits at 6
and 12 months were not scheduled because assessment of recurrences was not the purpose of the study. However, there is a need
for continued follow-up of these patients as recurrences can occur
later than 3 months post-treatment. On the other hand, our findings of a similar clearance rate for primary and recurrent tumours
may be related to the small number of recurrent lesions in this
study.
On the other hand, the present findings support the effectiveness of topical imiquimod in sBCC located on the face. In contrast
to target tumour locations in clinical trials predominating in the
trunk and extremities,9,10 the face was the most common site in
our study followed by the trunk and extremities. In this respect,
the effectiveness of imiquimod was unrelated to size and location
of lesions.
Application site reactions occurred in a high percentage of cases
(85%) but the intensity was mild or moderate in most of them.
These consisted largely of erythema followed by erosion, crusting
and oedema, and in general were managed adequately with rest
periods. The fact that rest periods were only indicated in 3.3% of
the tumours (with a mean of five rest days) is a further indicator
of the mild intensity of local site reactions. However, in nine
(2.4%) patients, local skin reactions were severe enough to cause
discontinuation. In a pooled analysis of two phase III, randomized, vehicle-controlled studies,9 4% of subjects in the imiquimod
five times per week group discontinued because of an AE or local
site reaction. In this study, it was observed that the proportion of
subjects experiencing application site reactions during the treatment period was significantly higher in the seven times per week
imiquimod group compared with the five times per week group.9
In this study, the five times per week dosing regimen was used.
Moreover, deviations from the product technical specifications in
the number of applications per week were recorded in only 8.3%
of cases (39 471 target sBCC). This finding is clinically relevant
and confirms the correct prescription of imiquimod.
Despite the fact that the high prevalence of application site reactions noted in daily practice conditions, the degree of patients satisfaction with imiquimod was very high (82% of patients were
very satisfied or satisfied), which may be explained by the high
clearance rate and the mild intensity of local skin reactions. In two
studies evaluating the use of imiquimod for the treatment of external genital warts, patients satisfaction was 86.5% and 89.1%
respectively.21,22 Patients satisfaction with the use of topical imiquimod in sBCC has not been addressed in previous studies.
In our study, a compliance of more than 80% with imiquimod
regimen was found in 99% of the patients. This high compliance
rate should be interpreted with caution, taking into account that

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Imiquimod for superficial basal cell carcinoma

diary cards were only collected for 46% of the target tumours.
However, no previous data on compliance with imiquimod therapy in patients with sBCC in routine daily practice have been
reported.
In summary, the present data from a prospective, observational
and multicentre study carried out in daily practice conditions adds
evidence for the usefulness and favourable clinical profile of imiquimod 5% cream when used for the treatment of sBCC.

1309

16

17
18
19

Acknowledgements
The authors are grateful to Patricia Ramrez, DPharm, Medical
Department, MEDA Pharma, for valuable support in the logistics aspects of the study and critical comments of the final
draft and Marta Pulido, MD, for editing the manuscript and
editorial assistance.

20

21

22

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Appendix
BASALE Study Group: N Perez Oliva, C Raya, J Sanchez del
Ro, and J Santos Juanes, Hospital Universitario Central de
Asturias, Oviedo; JR Curto, Ambulatorio de Mieres Norte,
Mieres; A Vila, A Llambrich, R Taberner, and C Nadal, Hospital Son Lla`tzer, Palma de Mallorca; V Rocamora, MC Sanchez
Bermejo, B Bartolome Gonzalez, and M Pascual Lopez, Hospital de Manacor, Manacor; F Mestre Bauza, T Alabau Sabater,
A Bauza Alonso, J del Pozo Hernando, A Martn Santiago, and
MA Ventayol Ventayol, Hospital Son Dureta, Palma de Mallorca; A Noda, M Saez Rodrguez, M Garca Bustnduy, M
Rodrguez Martn, and N Perez Robayna, Hospital Universitario de Canarias, Santa Cruz de Tenerife; L Borrego, E Soler
Cruz, and B Hernandez Machn, Hospital Insular, Las Palmas
de Gran Canaria; J Suarez Hernandez, S Dorta Alom, L Feliciano Divasson, and R Villalba Caballero, Hospital Nuestra Senora de la Candelaria, Santa Cruz de Tenerife; MA Rodrguez
Prieto and I Ruiz Gonzalez, Hospital de Leon, Leon; T Hernadez Llorente, Hospital Provincial de Avila, Avila; R Gimenez
Garca, Hospital Ro Hortega, Valladolid; P de Unamuno, I
Hernandez Vicente, and M Romero Riesco, Hospital de Salamanca, Salamanca; MC Gutierrez Ortega, Hospital Militar de
Burgos; E Dauden and Y Delgado, Hospital de la Princesa,
Madrid; M Garca Rodrguez, L Trasobares Marugan, S Medina Montalvo, and M Ruano del Salado, Hospital Prncipe de
Asturias, Alcala de Henares, Madrid; C Vidaurrazaga, Hospital
La Paz, Madrid; JL Lopez Estebaranz, E Naz Villalba, and E
Gomez de la Fuente, Fundacion Alcorcon, Alcorcon, Madrid; J
Liron de Robles, Hospital Central de la Defensa, Madrid; JM
Arrazola, C Garca Millan, and L Ros, Hospital Ramon y
Cajal, Madrid; C Zarco and M Gonzalez, Hospital Doce de Octubre, Madrid; P Fernandez Lopez, C Galvan Casas, C Lamoneda Herrern, J Sopena Barona, and E Zamora Martnez,

2011 The Author

Journal of the European Academy of Dermatology and Venereology 2011 European Academy of Dermatology and Venereology

Dauden

1310

Hospital de Mostoles, Madrid; M Gallego Cullere, ME Iglesias

Zamora, and JI Yanguas Bayona, Hospital Virgen del Camino,
Pamplona; L Cascante Daz and M Hervella Garces, Hospital
Garca Orcoyen, Estella, Navarra; R Matheu Lozano, MC Martn de Aguilera Moro, MP Hernandez Orta, and RF Lafuente
Urrez, Hospital Reina Sofa, Tudela, Navarra; S Aparicio, Fundacion Hospital Calahorra, Calahorra, La Rioja; R Soloeta
Arechavala, R Gonzalez Perez, I Attue Mitxelena, L Carnero
Gonzalez, I Garca Ro, I Trebol Urra, and MA Arregui Mur-

JEADV 2011, 25, 13041310

ura, Hospital Santiago, Vitoria-Gasteiz; E Aramburu Aguirre,

Hospital Oncologico, San Sebastian; A Lopez Pestana, J Zubizarreta Salvador, B Aseginolatza Zabaleta, P Eguino Gorrochategui, and A Tuneu Valls, Hospital de Donostia, San
Sebastian; JM Careaga Alzaga, A Sanchez Dez, I Martnez de
Lizarduy, and O Lasa Elgezua, Hospital de Basurto, Bilbao;
and MP Manrique Martnez, S Vildosola Esturo, A Arechalde
Perez, and I Bilbao Badiola, Hospital de Galzakao, Galdakao,
Bizcaia, Spain.

2011 The Author

Journal of the European Academy of Dermatology and Venereology 2011 European Academy of Dermatology and Venereology

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