I have Basal Skin Cancer on my left cheek. It is Micro Nodular not Superficial. I do not want a big scar from Moh's or Excision or Photo or Laser. I have done my research on Aldara/Zyclara. I know it is used on pre-cancerous or superficial skin cancers but I would like to try it and see how it goes. It is new to the market and I am a believer tha I think it might work. What do you think?
Is it Worth Trying Aldara/Zyclara Before Going Through with Mohs Surgery?
Doctor Answers 4
Mohs vs. Aldara for Basal Cell Cancer
I agree that Aldara is not recommended for a micronodular basal cell cancer. I recommend Mohs surgery for micronodular BCC which is considered a more aggressive subtype. Mohs surgery will remove the cancer and give you the highest cure rate. Surgical closure of a wound on the cheek typically leaves excellent results with an inconspicuous scar.
Most likely will not help.
I helped with a study that examined this when I was a resident. Unfortunately, I cannot post links anymore. Go to pubmed.org and search for 19018814 to get the abstract.
Basically, the benefit is questionable (if there is any). The absorption of imiquimod is not deep enough to get the dermal component of many basal cell carcinomas. A micronodular BCC is a more aggressive histologic subtype of BCC. Therefore, imiquimod (Aldara / Zyclara) is not appropriate for this subtype. You need histologic clearance with the Mohs technique performed by a fellowship-trained surgeon to get the best outcome.
Aldara vs. Mohs
Aldara only works for the most superficial of skin cancers (and obviously pre-cancers). If you treat a lesion with Aldara instead of surgically removing it and getting pathological confirmation that it is gone, you run the risk of allowing the roots to continue to grow down and around the scar of the superficially treated lesion. While this may be a risk willing to be taken off the face, it is not a good place to wind up having a recurrent skin cancer years down the road and needing major reconstructive surgery for.
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Aldara/Zyclara vs Mohs for BCC
Most often we recommend Mohs because some cancers can have a form of roots, which run deeper and wider under the skin layers. Using a topical treatment like Aldara/Zyclara cannot get to these roots. So even if you use it and the top of the skin appears better, the deeper roots and layers can still be effected by the BCC and can continue growing and expanding. This is why it's not recommended for this type of cancer.
Second, the purpose of Mohs is to take as minimal amounts of skin out as possible. That's why slides are made during the procedure so your doctor only has to take out the affected, cancerous areas. Thus, you will be left with the most minimized scar possible. Mohs is your best option here, and trying Aldara/Zyclara will only delay and possibly worsen what needs to be taken out.
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.