The combined effect of CO2 laser, topical diclofenac 3%, and imiquimod 5% in treating high‐risk basal cell carcinoma

Background Some basal cell carcinoma (BCC) patients are considered as a high risk regarding the site, size, histopathological variant, or recurrence. High‐risk BCC is a challenging therapeutic problem due to the trial to balance between complete surgical excision from one side and tissue preservation from the other side. Aim To evaluate the efficacy of combining ablative CO2 laser, imiquimod 5%, and diclofenac 3% as a therapeutic regimen in high‐risk and inoperable BCC. Patients/Methods The study was conducted on 14 patients that were assessed clinically and pathologically then categorized regarding the site, size, histopathology, and fitness for surgery as high‐risk inoperable BCC. They received an ablative session of CO2 laser, followed by application of diclofenac sodium 3% gel once daily for 5 days and imiquimod 5% cream for another 2 days. Results The study included 11 males and 3 females. Nine lesions were located on the scalp, 4 on the face, and one lesion on the trunk. All lesions were of large size >5 cm in diameter. Histopathology showed 4 patterns: nodular type in 8 patients, infiltrating type in 3 patients, metatypical type in 2 patients, and micronodular type in one patient. At the end of the treatment period, 9 patients showed significant (moderate to marked) improvement while 5 patients showed weak (poor to mild) response. Significant improvement was more observed in nodular type. Relapse was more observed during the 5th to 6th months with 2 patients showed no relapse. Conclusion This combined regimen is a good alternative therapeutic modality in high‐risk inoperable BCC especially the nodular pathologic pattern.