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Recurrence rate of superficial basal cell carcinoma following treatment with imiquimod 5% cream: conclusion of a 5-year long-term follow-up study in Europe. by Harald Gollnick

"Hop up on the table, Honey." mThat's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't. This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system. We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year-almost $8,000 per person." That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and thos

"Hop up on the table, Honey." mThat's how an x-ray technician addressed my 89-year-old mother-in-law in 2001, when we took her for knee x-rays. Mom, who had advanced osteoporosis and arthritis as well as confusion and heart problems, had long since given up hopping. When it became obvious that she needed assistance, the technician grabbed her arm -- as if pulling on another sore appendage would magically raise the rest of her onto the table. It didn't. This incident has become our personal mantra for expressing what is wrong with America's health care system. Having helped our four parents during their final years and having both had cancer ourselves as well as other medical problems, we have had experiences with five nursing homes, two personal care facilities and a half dozen hospitals. We've lost count of the doctors, drugstores and health insurance plans. All of us have had health insurance, though some policies were better than others. Nonetheless, we have experienced incident after incident demonstrating the waste, ignorance and apathy which is rampant in the system. Unable to list them all, I have been heretofore reluctant to write about a handful of them lest the reader be persuaded that the problem is with only that hospital, only that nursing home or only that doctor. There is, however, an increasing crisis of confusion, mismanagement and ill-preparedness which is at the core of our healthcare system. We are all familiar at least with the trend line if not the specifics for healthcare costs. According to WhiteHouse.gov, "The United States spends over $2.2 trillion on health care each year-almost $8,000 per person." That's sixteen percent of the economy. Healthcare costs are projected to increase to almost twenty percent ($4 trillion a year) by 2017. Meanwhile forty-six million Americans are without health insurance (14,000 more each day), premiums and co-pays are rising and more reasons are used to refuse coverage both to those willing to pay and thos

The estimate of overall treatment success for all treated patients at the end of follow-up was 77.9% (80.9% considering histology). The data support clinical assessment of initial response as predictive of long-term outcome. Most of the recurrences occurred early, indicating that careful follow-up is important during the first year after treatment.

PDF, Free full text article... We found that 5% imiquimod cream is aneffective treatment option for superficial and nodularbasal cell carcinomas, giving a clearance rate of89.5% at an average of 39 months of follow up.   Dr Yin Vun, Siller Medical, 9th Floor, SilvertonPlace, 101 Wickham Terrace, Brisbane, Qld 4000, Australia.

Prognosis (Outlook) The rate of basal cell skin cancer returning is about 1% with Mohs surgery, and up to 10% for other forms of treatment. Smaller basal cell carcinomas are less likely to come back than larger ones. Basal cell carcinoma rarely spreads to other parts of the body. You should follow-up with your doctor as recommended and regularly examine your skin once a month, using a mirror to check hard-to-see places. Call your doctor if you notice any suspicious skin changes.

We found that 5% imiquimod cream is an effective treatment option for superficial and nodular basal cell carcinomas, giving a clearance rate of 89.5% at an average of 39 months of follow up.

The proportion of subjects who were clinically clear at the 2-year follow-up visit was estimated to be 82.0%. Imiquimod was tolerated when applied daily, with erythema reported for all subjects participating in the study. The recurrence rate observed suggests that once daily dosing and 5x/week dosing yield similar clearance rates, but daily dosing increases local skin reactions.

FDA-approval:  * Biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults; maximum tumor diameter of 2.0 cm on trunk, neck, or extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured (1.2)

Superficial Basal Cell Carcinoma Aldara™ cream is indicated for the topical treatment of biopsy-confirmed, primary superficial basal cell carcinoma (sBCC) in immunocompetent adults, with a maximum tumor diameter of 2.0 cm, located on the trunk (excluding anogenital skin), neck, extremities (excluding hands and feet), only when surgical methods are medically less appropriate and patient follow-up can be reasonably assured.  The histological diagnosis of superficial basal cell carcinoma should be established for other types of basal cell carcinomas, including nodular, morpheaform (fibrosing or sclerosing) types.

The proportion of subjects who were clinically clear at the 2-year follow-up visit was estimated to be 82.0%. Imiquimod was tolerated when applied daily, with erythema reported for all subjects participating in the study. The recurrence rate observed suggests that once daily dosing and 5×/week dosing yield similar clearance rates, but daily dosing increases local skin reactions.

Eight of nine individuals, 89% (95% CI 56% to 97%) were histologically clear of sBCC at 52 weeks.

The initial sBCC clearance rate was 90% (12-week post treatment), whereas the proportion of subjects who were clinically clear at 2 years (current time point) was estimated to be 79.4%. 

Daily intake of fruit and vegetables was associated with a lower risk of coronary heart disease when combined with a high dairy fat consumption...but not when combined with a low dairy fat consumption. Sara Holmberg, Anders Thelin and Eva-Lena Stiernström. Int. J. Environ. Res. Public Health 2009, 6, 2626-2638.