Role of non-surgical therapies in the management of periocular basal cell carcinoma and squamous intra-epidermal carcinoma

Background: Basal cell carcinoma (BCC) and squamous intra-epidermal carcinoma (IEC) are the most common periocular tumours and can be associated with significant morbidity. Five percent of imiquimod cream and photodynamic therapy (PDT) are popular non-surgical treatment options but are currently not licensed for periocular use.

Objectives: To review our experience with these treatments and summarize published literature (PubMed: up to September 2011).

Patients and Methods: We conducted a review of case notes for all patients with periocular BCC and IEC treated with either PDT or imiquimod, within National Health Service (NHS) Tayside, Scotland, from 1996 to 2009. Results: Six of 13 and five of 12 lesions treated with imiquimod (median duration of clearance = 35 months; range = 24-55 months) and PDT (median duration of clearance = 66 months; range = 4-80 months), respectively, achieved clinical clearance. The majority of patients in our series did manage to tolerate and continue both treatments, with no significant longer-term adverse effects.

Conclusions: Our limited experience along with published reports suggests that both imiquimod and PDT are effective in the treatment of periocular non-melanoma skin cancers in selected patients. However, surgical excision with margin control remains the gold standard for the treatment of periocular tumours.