Immunocryosurgery consists of cryosurgery applied to the tumor during continued topical treatment with 5% imiquimod cream. Initially this modality was evaluated in 13 patients with 21 basal cell carcinomas (BCCs) most of them (19 of 21) with at least one risk factor for relapse after surgery . Our present aim was to validate in a larger cohort of patients the satisfactory efficacy (95%) recorded in the aforementioned study.
Local Hospital Ethical Committee approval was granted and 59 consecutive patients (29 males; age: 40–92; average: 72,6) with a total of 105 BCCs were recruited from 1st October 2006 to 30 April 2009 after informed consent. Exclusion criteria were >5 tumors/patient at presentation, tumor size >5 cm and distance from the eyelids <0.5 cm. The patients were scheduled to be treated with a standardized immunocryosurgery treatment protocol consisting of 2–3 weeks daily 5% imiquimod cream (Aldara(tm), Meda), a, relatively mild, cryosurgery session (liquid N2, open spray, 2 cycles, 10–20 sec each) and 3 weeks of post-cryosurgery daily imiquimod application. Patients with clinically evident and biopsy confirmed tumor remnants one month after immunocryosurgery were termed as non-responders. Development of BCC tissue in a previously treated tumor was assigned as relapse.
The cohort had been followed for an average of 18.75 months (Range: 6–36 months). From the 105 tumors, 63 had unfavorable localization, 19 were ≥20 mm and 16 had recurred after surgery. After immunocryosurgery, 2 tumors cleared only partially and 5 relapsed after treatment. Thus, 103/105 BCCs achieved clinical clearance (98.1%) whereas 98/103 (95.1%) remain disease free during the follow-up period (cumulative efficacy 98/105=93.6%). From the 7 non-responders/relapsed tumors 2 had 3 risk-factors for relapse after surgery, 2 had 2 risk factors and 1 had 1 risk factor.
In the present study, immunocryosurgery was applied in a non-selected cohort of BCCs including, some large and recurrent from previous surgery tumors that would have consisted a treatment challenge. In conclusion, the efficacy of this combination modality highlights the significance of elucidating the pathophysiological mechanisms of immunocryosurgery.
1. Gaitanis G, Nomikos K, Vava E, Alexopoulos EC, Bassukas ID. Immunocryosurgery for basal cell carcinoma: results of a pilot, prospective, open-label study of cryosurgery during continued imiquimod application. JEADV 2009; 23:1427–1431.