|Year : 2014 | Volume
| Issue : 2 | Page : 195
Successful treatment of multiple facial basal cell carcinomas with imiquimod in a patient with chronic renal failure
Sedef Bayata1, Aylin Türel Ermertcan1, Gülsüm Gençoglan1, Görkem Eskiizmir2, Peyker Temiz3
1 Department of Dermatology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
2 Department of Otorhinolaryngology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
3 Department of Pathology, Faculty of Medicine, Celal Bayar University, Manisa, Turkey
|Date of Web Publication||26-Mar-2014|
Aylin Türel Ermertcan
Department of Dermatology, Celal Bayar University School of Medicine, 45010 Manisa
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
Bayata S, Ermertcan AT, Gençoglan G, Eskiizmir G, Temiz P. Successful treatment of multiple facial basal cell carcinomas with imiquimod in a patient with chronic renal failure. Indian J Dermatol Venereol Leprol 2014;80:195
|How to cite this URL:|
Bayata S, Ermertcan AT, Gençoglan G, Eskiizmir G, Temiz P. Successful treatment of multiple facial basal cell carcinomas with imiquimod in a patient with chronic renal failure. Indian J Dermatol Venereol Leprol [serial online] 2014 [cited 2019 Jun 19];80:195. Available from: http://www.ijdvl.com/text.asp?2014/80/2/195/129439
We would like to report a case of multiple, pigmented basal cell carcinomas (BCCs) on the face in a patient with chronic renal failure, which responded dramatically to imiquimod therapy.
A 49-year-old woman, with chronic renal failure presented with dark brown patches on her face for 8 years [Figure 1]a. These were most prominent on her cheeks and had increased in size and number over the years. Dermoscopic examination revealed large, gray-blue ovoid nests, linear and arborizing vessels, maple leaf-like and scar-like areas as well as ulcerations [Figure 1]b, which were characteristic for BCC.  The diagnosis was confirmed by skin biopsy from one of the representative lesions [Figure 2]. The patient was advised topical application of imiquimod (5%) cream, 5 days a week. This was continued until there was complete resolution on clinical and dermoscopic examination [Figure 3] in approximately 1 year. Clinical and dermoscopic follow-up of the patient demonstrated no sign of recurrence after 10 months.
|Figure 2: Groups of basaloid cells with peripheral palisading in BCC (H and E, ×100)|
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BCC is the most common form of skin cancer and accounts for approximately 80% of non-melanoma skin cancers. The major treatment modalities for BCC include electrodesiccation, cryotherapy and curettage, which are often selected for low-risk lesions. However, surgical excision is considered the gold standard because it permits assessment of histopathologic margins.  However, excision of multiple facial lesions is generally not preferred due to unsatisfactory cosmetic outcomes. Imiquimod, a toll-like receptor-7 agonist, which belongs to a novel class of immune response modifiers, is a topical agent for the treatment of superficial BCC. It decreases tumor cell proliferation, increases tumor apoptosis and inhibits angiogenesis. It is also a potent inducer of interferon α in vivo, which has potent antitumor and antiviral activity. 
Renal transplantation is known to be associated with an increased incidence of non-melanoma skin cancers possibly related to use of immunosuppressant drugs. Both squamous cell carcinoma and BCC, the two major histological types of non-melanoma skin cancers, exhibit a more aggressive biological and clinical course in renal transplant recipients, with higher rates of recurrence and mortality than the general population.  The incidence of BCC in the general white population is between 18% and 40%  while a study in The Netherlands, revealed that the incidence of BCC in transplant recipients was 10 times higher than the general population. 
End stage renal disease is also a cause of immunosuppression in itself as both T and B-cell functions are reported to be altered possibly due to the uremic state. , Though there is an increased prevalence of various neoplasms in this setting,  specific data on skin neoplasms has not been reported so far.
Our patient had developed multiple and progressive facial lesions of BCC following a diagnosis of chronic renal failure. Her only medications were the anti-hypertensives amlodipine besylate and olmesartan medoxomil. Such multiple lesions may be attributable to the immunosuppression occurring as a part of end stage renal disease . Excision was not considered appropriate for multiple lesions on the face because of the risk of a poor cosmetic outcome Treatment with imiquimod 5% cream led to significant improvement in all lesions.
Imiquimod 5% cream is likely to be a promising agent for the treatment of multiple BCCs in similar settings.
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[Figure 1], [Figure 2], [Figure 3]