What Lies Beneath? A Lesson for the Clinician. Intraoperative Frozen Section Appearance of Persistent Basal Cell Carcinoma after Apparent Cure with Imiquimod 5% Cream

Prevalence of Underdiagnosed Aggressive Non-Melanoma Skin Cancers Treated with Mohs Micrographic Surgery

“…More troubling is subsequent treatment with nonexcisional modalities that are less likely to address possible subclinical spread or a more deeply invasive component. Instead, by treating the superficial portion of the malignancy, these therapies might create the impression of clinical cure while delaying definitive therapy and allowing more time for subclinical spread 4,5 …”

“…Instead, by treating the superficial portion of the malignancy, these therapies might create the impression of clinical cure while delaying definitive therapy and allowing more time for subclinical spread. 4,5 In this study, we did not evaluate the method of biopsy or lesion size for the treated tumors. Large tumors with small sampling biopsies are more likely to show discrepancy between the preoperative biopsy and diagnosis during MMS, and most physicians generally perform small biopsies in cosmetically sensitive areas of the head and neck, especially for lesions whose malignant nature is equivocal.…”

Efficacy and Safety of Laser‐Assisted Combination Chemotherapy: An Explorative Imaging‐Guided Treatment With 5‐Fluorouracil and Cisplatin for Basal Cell Carcinoma

“…Topical alternatives such as 5-fluorouracil (5-FU), imiquimod, and photodynamic therapy have been used for tumors with low risk of recurrence, with the largest comparative trial reporting 5-year cure rates of 70%, 81%, and 63% for superficial BCC (sBCC), respectively [8]. For other BCC subtypes, however, topical monotherapy is not recommended; potentially due to insufficient skin penetration, suboptimal drug action, reliance on patient adherence, and mixed intratumoral histology [9][10][11][12]. Enhancing topical treatment potency and ensuring adequate delivery to deep skin layers may improve therapeutic outcomes.…”

Imiquimod 5% cream as pretreatment of Mohs micrographic surgery for nodular basal cell carcinoma in the face: a prospective randomized controlled study

“…Some researchers state that a destructive therapy like imiquimod has a certain risk of incomplete cure, leaving behind independent tumour nests, which could lead to false‐negative results if MMS is performed afterwards 18 . Studies in which the complete area after treatment with imiquimod was excised did in some cases show remaining tumour nests which were found in the dermis 5,19,20 . We acknowledge this fact, but we believe risk is minimal, as MMS is performed around the tumour starting with a margin of 2–3 mm, taking subcutis with the first stage, and it shows nearly 100% of margins.…”