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Imiquimod can be combined with cryosurgery (immunocryosurgery) for locally advanced periocular basal cell carcinomas
  1. Georgios Gaitanis1,
  2. Christos Kalogeropoulos2,
  3. Ioannis D Bassukas1
  1. 1Department of Skin and Venereal Diseases, University of Ioannina Medical School, Ioannina, Greece
  2. 2Department of Ophthalmology, University of Ioannina Medical School, Ioannina, Greece
  1. Correspondence to Dr Ioannis D Bassukas, Department of Skin and Venereal Diseases, Medical School, University of Ioannina, University Campus, 45110 Ioannina, Greece; ibassuka{at}cc.uoi.gr

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Recent reports of case series support the efficacy and safety of topical imiquimod in the treatment of periocular skin tumours.1 2 Cryosurgery is an established ‘non-surgical’ treatment modality for these tumours, particularly for eyelid basal cell carcinomas (BCCs).3 Ongoing studies from our group indicate that the targeted combination of cryosurgery with imiquimod is a highly efficacious modality for BCCs and Bowen's disease of the skin.4 5

This letter aims to contribute to the current discussion on imiquimod-based treatment modalities for the management of skin tumours involving eye structures.1 2 We present three patients with biopsy proven, locally advanced periocular BCCs, who refused surgery and were treated with the combination ‘cryosurgery during continuing imiquimod application’ (immunocryosurgery).4 For immunocryosurgery, a commercial imiquimod 5% cream formulation (Aldara®, MEDA) was prescribed, and the patients were instructed to apply a tiny quantity (approximately 20–30% of the sachet content) on the tumour (including an ∼0.5 cm zone of healthy skin around it) every night at bedtime and wash it with tap water the following morning. Cryosurgery was performed by the open spray liquid N2 method employing a Cry-Ac (Brymill, UK) cryogun, with a tip B, under eye surface tetracain anaesthesia. Daily imiquimod application was not interrupted—even at the evening of the day that cryosurgery was performed. We have observed that omitting daily application of …

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