Nodular basal cell carcinoma of the face successfully treated with ingenol mebutate 0.015% gel

Abstract

Surgical excision is the first-choice treatment for basal cell carcinoma (BCC). Other treatments with topical agents such as 5-fluorouracil or imiquimod have also been suggested for use in superficial BCC (sBCC). Ingenol mebutate (IM) is a novel agent employed in the treatment of superficial actinic keratoses. The drug has been also successfully used in the treatment of sBCC. A case of large nodular BCC (nBCC) of the face in a 100-year-old inoperable woman is described. IM 0.015% gel was applied once daily for three consecutive days. This dose regimen was repeated for seven rounds within 11 months, with complete cure of the tumor. Mild local skin reactions, which were tolerated well, were observed. Selected cases of nBCC could be treated with IM gel, but the optimal concentration of the drug and the standard dose regimen of treatment are yet to be determined.

Basal cell carcinoma treated with combined ablative fractional laser and ingenol mebutate – an exploratory study monitored by optical coherence tomography and reflectance confocal microscopy

“…Ablative fractional laser pretreatment of sBCC in our study resulted in clearance rates similar to sBCC treated with IM alone reported in the literature, possibly suggesting limited advantaged of AFL pretreatment for this subtype. For nBCC, however, our data could indicate a potential benefit of AFL pretreatment prior to IM application . The hypothesis may be investigated in future studies focusing on BCC subtypes.…”

“…Single applications of 0.05% to sBCCs in 8 days intervals resulted in low clinical (13%) and histological (35%) clearance rates, suggesting importance of applying IM consecutively within few days. Few cases of nBCCs treated with IM have been reported and concentrations of both 0.015% and 0.05% cleared nBCCs . However, 11 treatments were required for the 0.015% concentration.…”

“…Ingenol mebutate was previously applied to sBCCs in concentrations of 0.05% for two consecutive days in several, mostly small studies or case reports reporting cure rates ranging from 63% to 100% at 3-to 15-month follow-up. [4][5][6][7][8][9][10] Single applications of 0.05% to sBCCs in 8 days intervals resulted in low clinical (13%) and histological (35%) clearance rates, 5 suggesting importance of applying IM consecutively within few days. Few cases of nBCCs treated with IM have been reported and concentrations of both 0.015% and 0.05% cleared nBCCs.…”

“…For nBCC, however, our data could indicate a potential benefit of AFL pretreatment prior to IM application. 4,10 The hypothesis may be investigated in future studies focusing on BCC subtypes.…”

“…IM concentration of 0.015% applied for three consecutive days is approved for AKs on the scalp and face and IM concentration of 0.05% applied for two consecutive days is approved for trunk and extremities. In case reports and phase I/II trials, off‐label application of IM to superficial and nodular BCCs resulted in cure rates ranging from 13% to 100% evaluated at 3‐ to 15‐month follow‐up, suggesting that IM may be effective for treatment of low‐risk BCCs . IM has a dual mechanism of action, causing initial cell death followed by immune activation .…”