Imiquimod

Imiquimod (Aldara®)

Cancer cells are not normal cells and therefore the body can recognize the change and can kill the atypical cells. Many new cancer treatments work by boosting the body’s natural immune response to help kill the atypical cancer cells. Such treatments include melanoma vaccines.

Aldara, also known as imiquimod, is a topical cream that can be used to treat pre-cancerous growths (called actinic keratosis), basal cell carcinoma, squamous cell carcinoma, and genital warts. This medication is applied topically in the form of a cream or gel. Imiquimod is an immunomodulator, which acts by revving up the immune system so one’s body can fight off atypical cells. This cream was FDA-approved for the treatment of superficial basal cell carcinomas in 2004. Clinical studies have proven that this treatment is at least 80% effective for early basal cell carcinomas (superficial type). Many studies have shown successful treatment of other types of basal cell carcinoma and squamous cell carcinoma in situ. Invasive squamous cell carcinoma has been treated with this medication, although as these tumors do have the potential to metastasize caution must be exercised and it is not recommended as a primary treatment when other treatment options exist.

Why isn’t this medication used for all skin cancers?

There are several reasons for that.

  1. Most other treatment options for basal cell carcinoma and squamous cell carcinoma have a higher cure rate and are thus often recommended.
  2. Cost. This medication used to cost approximately $600. Some insurance carriers will not pay for “off label use”–when a product is not FDA approved for that type of skin cancer. Now the cost has fallen and is under $200. With discount coupons patients can often get the medication for under $20 for a box of 12.
  3. Time. The product is used for well over a month and many patients do not want to be bothered.
  4. Skin irritation and crusting is common and expected with the use of this cream. Scabbing is common and often not attractive. Although this reaction does not go on for the full treatment, it is often present for several weeks.
  5. Physician’s often do not discuss this treatment or offer it as an option to patients. When giving informed consent for any procedure, informed consent must be obtained, including the discussion of alternative options. Some physicians choose not to use this as the cure rate is lower than other options and it is only FDA approved for the treatment of actinic keratosis and superficial basal cell carcinoma that is not on the face. Some physicians may discuss 5-fluorouracil (Efudex or Carac) as another topical treatment option that has similar cure rates for the treatment of actinic keratosis and superficial basal cell carcinoma, and was much less expensive than imiquimod until recently. Alternatively, our fee-for-service payment model rewards physicians for performing “procedures”, which have much higher reimbursement rates than office visits.
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Is imiquimod best for me?

This medication is a very good option for the treatment of actinic keratosis and many superficial basal cell carcinomas and squamous cell carcinoma in situ. One must be willing to use the medication for 8 weeks, if not longer, and have moderate irritation and scabbing. As the cost of this medication has come down significantly, it now is almost always a less expensive option when compared to almost any surgical or non-surgical treatment. Sites heal very well with no scar, although very slight discoloration is possible and improves with time.