H. Foong1, N. Shaikh1, H. Liang1, D. Yakoub1 1University Of Miami,Division Of Surgical Oncology At Department Of Surgery,Miami, FL, USA
Introduction: Extent of surgery for BCC in the face continues to be a cosmetic challenge. Moh’s micrographic surgery is successful in reducing that extent with equal oncologic results. We aimed to evaluate the role of pre-surgical 5% Imiquimod cream application in reducing defect size.
Methods: Online database search of PubMed, MEDLINE, EMBASE, SCOPUS, COCHRANE, and GOOGLE SCHOLAR was performed; key bibliographies were reviewed. Studies comparing patients using preoperative 5% Imiquimod followed by surgery to those who had surgery alone were analyzed. The primary end point was defect size at surgery for similar sized tumors. Relative risk with the corresponding 95% confidence intervals (CI) were calculated by random effect models of pooled data. Study quality was assessed using STROBE criteria.
Results:27 Articles were identified, amongst those, 3 studies met our selection criteria. Mean BCC size was 92.42mm2. Most common histologic type was nodular. Average lesion size was 227.8mm2. Meta-analysis of included data showed that application of 5% Imiquimod cream one time daily, 5 days/week for 4 weeks significantly reduced the defect size of the Moh’s micrographic surgery resection with a combined mean difference of -80.37 mm2 (95% CI: -106.67, -54.08, P<0.001). A regimen of similar frequency for 6 weeks showed similar trend compared to 4 weeks, yet did not achieve statistical significance with an additional mean difference of -10.24 mm2 (95% CI: -31.68, 11.20, P=0.35).
Conclusion:5% Imiquimod cream application in BCC of the face, using a regimen of 4 weeks may reduce the defect size of the Moh’s micrographic surgery.