A Case Report of Eyebrow Basal Cell Carcinoma Successfully Treated with 5% Imiquimod Cream

Byeong Soo Kang; Nam Ju Kim; Ho Kyung Choung; Sang In Khwarg

doi:10.3341/jkos.2015.56.11.1789

Journal List > J Korean Ophthalmol Soc > v.56(11) > 1010148

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Kang, Kim, Choung, and Khwarg: A Case Report of Eyebrow Basal Cell Carcinoma Successfully Treated with 5% Imiquimod Cream

Original Article

J Korean Ophthalmol Soc 2015;56(11):1789-1793.

Published online: 29 August 2015

DOI: https://doi.org/10.3341/jkos.2015.56.11.1789

A Case Report of Eyebrow Basal Cell Carcinoma Successfully Treated with 5% Imiquimod Cream

Byeong Soo Kang, M.D¹, Nam Ju Kim, M.D^1,², Ho Kyung Choung, M.D^1,³, Sang In Khwarg, M.D^1,

¹Department of Ophthalmology, Seoul National University College of Medicine, Seoul, Korea

²Department of Ophthalmology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea

³Department of Ophthalmology, Seoul Metropolitan Government Seoul National University Boramae Medical Center, Seoul, Korea

Address reprint requests to Sang In Khwarg, MD Department of Ophthalmology, Seoul National University Hospital, #101 Daehak-ro, Jongno-gu, Seoul 03080, Korea Tel: 82-2-2072-2879, Fax: 82-2-741-3187 E-mail: khwarg@snu.ac.kr

Received 29 May 201522 June 2015 Accepted 4 September 2015

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

Basal cell carcinoma is the most common malignant neoplasm of the skin. Periorbital basal cell carcinoma needs to be treated for cosmetic improvement and prevention of intraorbital invasion. Although surgical excision is a standard treatment, nonsurgical treatment using imiquimod cream, a topical immunomodulator, has been attempted. The authors report the first case of periorbital basal cell carcinoma successfully treated with imiquimod cream; to the best of our knowledge, similar cases have not been published to date in the Korean ophthalmology journals.

Case summary

A 73-year-old female visited our hospital for treatment of a biopsy-proven basal cell carcinoma in the right eyebrow. A flat, elevated, 1 x 1 cm-sized mass having central indentation was observed in the centromedial area of the right eyebrow. She was treated with 5% imiquimod cream once daily at night, 5 days per week for 6 weeks. Eight weeks after the treat-ment with imiquimod cream was discontinued, the mass was flattened and the cilia began to grow on the mass site. Under the impression of a partial regression, an additional 4 weeks of application was recommended. The mass disappeared more and her eyebrow became more normal. At the final follow-up 31 months after treatment, her right eyebrow appeared normal.

Conclusions

Imiquimod cream may be a useful medication which can be used for complex periorbital basal cell carcinomas that are difficult to reconstruct after resection or surgical candidates with poor general condition.

Keywords: Imiquimod cream, Periorbital basal cell carcinoma

References

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Figure 1.

External photography and the histopathological slides at her first visit. (A) An 10 × 10-mm-sized, flat, elevated lesion with minor central excavation is observed in the right centromedial eyebrow at her first visit. (B) The histopathological findings, HE stain, ×1.25 magnification: the invasive mass lesion is observed from the basal layer of the epidermis to the dermis. (C) The histo-pathological findings, HE stain, ×100 magnification: the clefts between stroma and tumor cell rest and necrotic lesion inside tumor cell are observed. (D) The histopathological findings, HE stain, ×400 magnification: the tumor cell apoptosis and mitosis are fre-quently observed. The tumor cell polymorphism is mildly observed. The basaloid cells that present thick granulated chromatins of nucleus surrounding thin pale cytoplasm with palisade arrangement of peripheral cells were observed. HE stain= Hematoxylin and eosin stain.

Figure 2.

External photography after medication. (A) Post-medication photo: at 1 week after starting 5% Imiquimod cream. A focal redness is observed in the right eyebrow lesion, but there is no other complication or symptom. (B) Post-medication photo: at 8 weeks after 6 weeks’ 5% Imiquimod cream application and just before additional treatment. Her eyelid lesion is flattened and the cil-ia of the eyebrow begun to grow on the lesion site. However, the lesion still remains giving an impression of a partial regression. (C) Post-medication photo: at 4 week after additional 4 weeks’ 5% imiquimod cream. Her eyebrow lesion disappeared more. (D) At 6 months after the last application of 5% imiquimod cream. The eyebrow is like normal appearance. (E) At 9 months after last application. (F) At 31 months after last application (final follow up), the eyebrow looks normal.

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