Aldara for the Treatment of Non-Melanoma Skin Cancers

Basal cell carcinoma is the most common type of skin cancer worldwide and is among the most curable if treated early. Common treatments include electrodesiccation and curettage (cauterizing and scraping the lesion), surgical excisiong, and Mohs surgery (a precision surgical technique).

Another form of treatment, known as Aldara (imiquimod) topical cream, was approved by the U.S. Food and Drug Administration in 2004 to treat superficial basal cell carcinoma (sBCC). It works by gently peeling away the lesion and can also be used to treat actinic keratosis (solar keratosis) and genital warts.

Indications for Use

Aldara cream is the only topical formulation used to treat SBCC in adults with normal immune systems. It is recommended when other methods of removal are inappropriate (such as where there are multiple lesions on the face). Aldara activates the immune system to produce a type of protein, known as interferon-alpha, to directly attack cancer cells.

Pre-market research showed that Aldara was able to clear sBCC in 75% of treated individuals; in contrast, placebo cleared only 2% of treated sBCC. Of those successfully treated with Aldara, nearly 80% remained cancer-free after two years.

While research is still ongoing, studies suggest that Aldara may be effective in treating early-stage melanoma (also known as melanoma in situ) if other surgical options are not available.

Treatment Considerations

Aldara is not appropriate for all individuals. Advise your healthcare provider if you are taking other forms of treatment for SBCC, actinic keratosis, genital warts, or any other skin conditions. If so, you may be advised to wait until the current treatment is completed and your skin has healed before starting Aldara.

Aldara may also worsen certain inflammatory skin conditions such as psoriasis.

It is not known if Aldara can harm a fetus during pregnancy or be transmitted to a baby through breast milk. Speak with your healthcare provider about both the benefits and potential consequences of Aldara if you are pregnant or planning to become pregnant.

Application

Aldara is applied to the skin only and should never be used in or near your eyes, lips, nostrils, or open wounds.

Aldara is usually applied only once daily for five days a week. It should be left on the skin for eight hours or overnight. Do not cover the treated area with bandages or other closed dressings. After eight hours, wash the affected skin with mild soap and water.

Treatment should continue for a full six weeks. Continue to use Aldara even if the basal cell lesion is gone unless told otherwise by your dermatologist.

Drug Side Effects

The most common side effect of Aldara is a localized skin reaction, which occurs in roughly a third of all cases. Dermatological symptoms may include:

• Redness
• Swelling
• Sore, blister, or ulcer
• Thickening or hardening of the skin
• Changes in skin color
• Skin peeling
• Scabbing and crusting
• Itching and/or burning

The area being treated is likely to look worse before it gets better. Avoid sunlight (or sunlamps) as this may worsen the symptoms. When outdoors, use protective clothing or a hat to cover the affected area. In some cases, any changes to the skin color or texture may be permanent.

Other potential side effects include headaches, back pain, muscle aches, tiredness, fever, swollen lymph nodes, diarrhea, and fungal infections.

Contact your healthcare provider immediately if you have a severe skin reaction, if you develop flu-like symptoms, or if sores begin to develop during the first week of therapy.

In rare cases, patients may have no reaction to Aldara; this may suggest the medication is not effective in them. Patients should contact their practitioner if they have no reaction to Aldara after applying it for one week.