There are 3 types of skin cancer: basal cell carcinoma, squamous cell carcinoma, and malignant melanoma.  By far, the most prevalent is the basal cell carcinoma.  It also has a great treatment success rate, 95%.  It typically occurs on people with fair skin and mostly appears as a small nodule on the skin.  This patient had a previous area diagnosed as a basal cell carcinoma that was successfully treated with Mohs surgery, which is a microscopically controlled surgery that allows precise removal of all skin cancer cells with very little of the surrounding normal tissue damaged.  See this site for more information:  http://www.mohssurgery.org/i4a/pages/index.cfm?pageid=1.          

The spot that we are going to follow had previously been biopsied and found not to be cancerous, but a new dermatologist decided to biopsy again and made the diagnosis.  Instead of Mohs, it was decided to treat with a topical application of Imiquimod, an immune response modifier and keratolytic.  How does it work?  Well, like you will find in many medications, “the exact mechanism of action is unknown”, but it does induce cytokine production.           

  

  After 3 applications the patient reports, “No burning. No pain or tenderness on the spot either.  They say potential flu-like side effects, but with 96 degree heat, 90% humidity, who can tell?”        

 After 4 applications the patient reports that it is getting a little raw, “It sort of “throbbed” last night after I applied the cream and went to bed.  I could feel it pulsate. Not really painful, but I might have to start applying gauze.”        

After application 3, 4, and 5 patient reporting flu-like symptoms, an expected adverse reaction of Imiquimod: fatigue, rhinorrhea, pyrexia, sore throat.  In addition, she is experiencing severe nausea.        

This picture is after 6 applications, 3 days after the previous picture with a weekend just prior to this application (remember, no weekend application).  It appeared to recover during the break from treatment but the patient says it is slightly more irritated after this application then it was before she went to bed.       

   This is a close up picture after the 7th application.  It appears to be irratated again, however the patient seems to be more concerned with the flu-like symptoms that have returned.  She reported the symptoms had abated with her two day weekend hiatus from Imiquimod applications, however they are back full strength after resuming with two additional applications.  She plans to report these observations to her physician.       

  This picture is also after the 7th application.  Note the scar tissue in the top left-hand corner of the picture.  This is from the Mohs surgery on the previous carcinoma.  An abscence of scarring is the reason the physician suggested trying the Imiquimod.