Krajewska-Węglewicz Larysa, Sobolewski Piotr, Walecka Irena
Department of Ophthalmology, National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.
Dermatology Clinic, National Institute of Medicine of the Ministry of Interior and Administration, 02-507 Warsaw, Poland.
Cancers (Basel). 2025 Jun 24;17(13):2111. doi: 10.3390/cancers17132111.
BACKGROUND/OBJECTIVES: To evaluate the clinical and histological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream, used in monotherapy or in combination, for periocular superficial and nodular basal cell carcinoma (BCC).
A systematic search of MEDLINE, PubMed, and Google Scholar (inception-12 June 2025) identified studies reporting IMQ treatment of eyelid/periocular BCC. Randomized, nonrandomized and observational designs were eligible. Risk of bias was assessed with Cochrane RoB 2 or ROBINS-I, and certainty of evidence graded with GRADE.
Seven studies ( = 152 lesions) met the inclusion criteria. The pooled clinical-plus-histological clearance across case series was 82% (95% CI 72-90%). The single RCT ( = 27) reported 100% histological clearance for both IMQ and radiotherapy at 3 months, but IMQ produced superior cosmetic results. Combination immunocryosurgery (IMQ + cryotherapy) achieved 87.5% sustained remission at ≤5 years. Local adverse events-erythema, crusting, or conjunctivitis-occurred in ≥70% (85/122) of treated cases but were mild-to-moderate and self-limiting; systemic reactions were not reported. Forty-seven additional patients in a dedicated safety cohort showed only transient ocular irritation. The certainty of evidence was moderate for short-term clearance and low for long-term control because of small samples and heterogeneous follow-up.
IMQ 5% is a useful, tissue-sparing option for selected (superficial and nodular subtypes) periocular BCCs where surgery is contraindicated or cosmesis is paramount. Overall clearance is slightly lower than Mohs surgery but comparable to radiotherapy, and cosmetic outcomes are favorable. Larger, standardized RCTs with ≥3-year follow-up are needed to confirm durability, optimize dosing schedules, and validate patient-reported outcome measures.
背景/目的：评估5%咪喹莫特（IMQ）乳膏单药治疗或联合治疗眼周浅表性和结节性基底细胞癌（BCC）的临床和组织学疗效、安全性及美容效果。
对MEDLINE、PubMed和谷歌学术（起始时间至2025年6月12日）进行系统检索，以确定报告IMQ治疗眼睑/眼周BCC的研究。随机、非随机和观察性设计均符合要求。使用Cochrane RoB 2或ROBINS-I评估偏倚风险，并用GRADE对证据的确定性进行分级。
七项研究（n = 152个病灶）符合纳入标准。病例系列的综合临床加组织学清除率为82%（95%CI 72 - 90%）。唯一的随机对照试验（n = 27）报告，IMQ和放疗在3个月时的组织学清除率均为100%，但IMQ产生了更好的美容效果。联合免疫冷冻手术（IMQ + 冷冻疗法）在≤5年时实现了87.5%的持续缓解。≥70%（85/122）的治疗病例出现局部不良事件——红斑、结痂或结膜炎，但为轻至中度且为自限性；未报告全身反应。专门安全队列中的另外47名患者仅出现短暂的眼部刺激。由于样本量小和随访异质性，短期清除的证据确定性为中等，长期控制的证据确定性为低。
对于手术禁忌或美容至关重要的特定（浅表性和结节性亚型）眼周BCC，5% IMQ是一种有用的、保留组织的选择。总体清除率略低于莫氏手术，但与放疗相当，且美容效果良好。需要开展随访≥3年的更大规模、标准化随机对照试验，以确认疗效持久性、优化给药方案并验证患者报告的结局指标。
