Treatment of basal cell carcinoma using a combination of pulsed dye laser and imiquimod – Case report and review

Abstract Objective: To evaluate the feasibility and efficacy of a pulsed dye laser (PDL) during a 5-week course of 5% topical imiquimod application in a patient with a nodular basal cell carcinoma (BCC) and to review the literature for data on PDL treatment of BCC. Methods: A 74-year-old patient with a 7-mm biopsy-proven BCC on his nose was treated with topical daily imiquimod for 2 weeks. Subsequently a laser session was performed with a flash lamp-pumped dye laser at 595 nm (Dermobeam 2000; Deka M.E.L.A., Florence, Italy) employing one pass with the following parameters: fluence 15 J/cm2, 3-ms pulses, spot diameter 5 mm with 10% overlap. PubMed was searched using the term conjunctions [“basal cell carcinoma” AND “pulsed dye laser”], [“basal cell carcinoma” AND “laser therapy”] and [“skin cancer” AND “pulsed dye laser”]. Frequency counts and percentages were employed to summarize identified BCC cases treated with PDL along different studies and Fisher’s exact test was used for the comparison of frequency distributions. Results: Topical imiquimod was continued for a further 3 weeks after the PDL session with a minimal increase in irritation. The tumor cleared and there has been no recurrence for 12 months. The literature search revealed a total of 7 small studies that included 120 tumors, the majority treated with a 595-nm device (104/120). Overall 81/120 (67.5%) treated tumors have been assessed as complete responders. No differences were recorded in relapse rates in association with the localization of the tumor, the histology (superficial vs. non-superficial), the wavelength of the device employed (595 vs. 585 nm), or the application of dynamic cooling. From the treatment parameters, only the use of multiple vs. single PDL sessions affected the outcome favorably (p=0.0432; Fisher’s exact test). From the BCC parameters, tumor size was a negative predictor of response. Conclusion: The combination of PDL with imiquimod could be a promising approach for the treatment of BCC and should be further evaluated in future studies.