Imiquimod cream 5% was shown to be an attractive alternative to surgical treatment of periocular BCC. Future studies with larger samples and longer follow-up periods are expected to provide more accurate information on the efficacy and safety of the drug.

BackgroundThe recurrence rate of periocular nodular basal cell carcinoma (PNBCC) following treatment with imiquimod (IMQ) has not yet been established. Previous studies did not include histological follow-up. The aim of this analysis was to evaluate the efficacy of topical immunotherapy with 5% IMQ cream for the treatment of PNBCC.MethodsStudy design: A prospective, non-randomized, and uncontrolled longitudinal case series study. No participants were blinded. Punch biopsy confirmed PNBCC patients were included at the Ophthalmology Clinic of São Paulo University Medicine School Hospital (from 2008 to 2012). Patients were treated with 5% IMQ cream once a day, 5 days per week, for 8–16 weeks. Standard lesion photographic documentation was done during the study. Three months after treatment ended, an image-guided biopsy was performed. Patients were followed at 6-month intervals and annually for control biopsies. Main outcome measures were clinical and histological clearance rates. Data were analysed by frequency distribution for qualitative group characteristics and central tendency measures for quantitative data.ResultsTwenty-four patients met the inclusion criteria, 19 of whom remained until the end of treatment. The histological clearance rate was 89.5% and 84.2%, respectively, at 3 and 39.5 months. The 3-year histological clearance rate was 81.8% (9/11) for lesions >10 mm, and 100% (8/8) for lesions <10 mm. Three patients did not tolerate the side effects of the medication and left the study. Two patients were excluded for treatment interruption related to comorbidities.ConclusionsOur results indicated that 5% IMQ cream was a useful alternative treatment for NBBCC, especially for lesions <10 mm. IMQ also showed a significant neoadjuvant effect on lesions >10 mm.Trial registrationClinicalTrial.gov Registration Dec 3, 2008: #NCT 00803907.

Purpose: Two-millimeter punch biopsy is a swift and practical diagnostic tool in the outpatient setting. However, few studies have evaluated the efficacy of the method for diagnosis of malignant eyelid tumors.Methods: This was an observational study of patients with suspicion of malignant eyelid tumor attending the Ocular Plastic Surgery Center at Hospital das Clínicas, University of São Paulo School of Medicine. Following standard procedures, preoperative biopsies were taken with a 2-mm trephine and surgical excision was performed with safety margins, followed by reconstruction. Anatomopathologic analysis of the surgical specimen was used as gold standard to evaluate the accuracy of diagnosis by punch biopsy.Results: The study included 50 periocular tumors with suspicion of malignancy. The indicators of efficacy in the identification of malignancy by 2-mm punch biopsy were: sensitivity 88%, specificity 100%, positive predictive value 100%, and negative predictive value 64%. Accuracy was 90% for malignancy and 80% for histologic type. The κ index of agreement between the diagnostic methods was 0.722 (p < 0.001).Conclusion: A positive result with 2-mm punch biopsy is a safe indication for surgical excision of the tumor, whereas a negative result does not necessarily imply benignity. In cases of high clinical suspicion, a second biopsy should be taken from a different part of the tumor to rule out malignancy. (Ophthal Plast Reconstr Surg 2012;28:282-285) A pproximately 5% to 10% of all skin neoplasms affect the eyelid. In fact, periocular malignancy is the most common type of neoplasm observed at our service.1 Due to their small size, periocular tumors can be hard to diagnose and surgery is often postponed when clinical findings are ambiguous. Despite considerable accuracy in the diagnosis of malignancy, clinical evaluation of patients with periocular tumors frequently yield false-positive and false-negative results, and on the average clinical and histologic findings are poorly correlated. 2-5Several factors have been associated with recurrence of periocular tumors after treatment, such as size, location, and medical conditions related to histologic type.6 Aggressive tumors require larger surgical margins and pose a greater risk of metastasis.Punch biopsy is a swift and simple diagnostic technique requiring very little equipment or surgical skill. A 2-mm trephine will collect a tissue sample large enough for analysis and no suture is necessary. The level of agreement between punch biopsy, conventional incisional biopsy, and histopathologic analysis of the surgical specimen is high. [7][8][9] Punch biopsy can be useful in preoperative assessments of skin disorders.7 However, the few published studies on punch biopsy in the periocular region-rarely cited by ophthalmologists-lack a complete evaluation of efficacy, especially with regard to histologic type. OBJECTIVEThe aim of this study was to evaluate the ability of 2-mm punch biopsy to diagnose malignancy and define the histologic type of eyelid tumors. MATERI...

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a acurácia e os indicadores de desempenho foram melhores para a biópsia por trépano de 2 mm em dois sítios do que em um sítio para o diagnóstico dos subtipos agressivos de CBC palpebral.