: Is Imiquimod 5% cream (US brand: Aldara) helpful as an adjunctive treatment of a facial basal cell carcinoma (BCC) prior to a Mohs surgery? I wonder whether Imiquimod 5% cream (US brand: Aldara) is not helpful as an adjunctive

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The 2018 systematic review {1} whether Imiquimod 5% cream (US brand: Aldara) is helpful as an adjunctive treatment of a facial basal cell carcinoma (BCC) prior to a Mohs surgery. Summary: Two studies show it is beneficial, and one shows it wasn't but that's unlikely because they looks at nasal BCC, which tends not to respond well to Imiquimod 5% cream. Quote from {1} with more details:

Some of the literature explores the option of pretreatment
with imiquimod 5% cream before Mohs surgery. In one
study, a total of 70 adults with primary nodular BCC were
identified, with one group given imiquimod 5% cream for
4 weeks prior to Mohs and the other treated only with Mohs
surgery. It was found that there was less of an increase in
tumor size and area from baseline, fewer Mohs stages, and
shorter reconstruction times in the group given neoadjuvant
imiquimod [22]. Another study used reflectance-mode
confocal microscopy as well as histological imaging to confirm
decreased tumor burden with the use of 5% imiquimod
cream used before Mohs excision. When two, four, and six
week regimens were tested in comparison to vehicle cream,
the four and six week regimen groups showed significant
reduction or clearance of tumors with confocal microscopic
findings that paralleled histologic diagnosis [23].
Of note, one study was found to have different findings. In
this study, a total of 31 patients were followed. Some applied
imiquimod cream each night for 6 weeks and underwent a
4 week rest period prior to having Mohs surgery, while the
others underwent only Mohs surgery. No differences were
found in the number of Mohs stages, tumor sizes, or costs
between the two groups. In the treatment group, 5 of 12
remaining patients were confirmed on histology to be clear
of tumor. In this study adjunctive imiquimod 5% cream
before Mohs surgery was not found to be useful in treating
nodular BCC, in fact the clearance of the nasal nodular BCC
pre-treated with imiquimod before Mohs was less than what
had been found in prior studies [24]. However, compared to
other studies, this study had a smaller sample size. Furthermore,
this study specified nasal BCCs, which may respond
less to imiquimod therapy.

[22]. van der Geer S, Martens J, van Roij J, Brand E, Ostertag JU,
Verhaegh ME, et al. Imiquimod 5% cream as pretreatment
of Mohs micrographic surgery for nodular basal cell carcinoma
in the face: a prospective randomized controlled study.
Br J Dermatol. 2012;167(1):110–5. doi.org/10.1111/j.1365-2133.2012.10924.x [23]. Torres A, Niemeyer A, Berkes B, Marra D, Schanbacher C, Gonzalez
S, et al. 5% imiquimod cream and reflectance-mode confocal
microscopy as adjunct modalities to Mohs micrographic surgery
for treatment of basal cell carcinoma. Dermatol Surg. 2004;30(12
Pt 1):1462–9. doi.org/10.1111/j.1524-4725.2004.30504.x [24]. Butler DF, Parekh PK, Lenis A. Imiquimod 5% cream as adjunctive
therapy for primary, solitary, nodular nasal basal cell carcinomas
before Mohs micrographic surgery: a randomized, double
blind, vehicle-controlled study. Dermatol Surg. 2009;35(1):24–9. doi.org/10.1111/j.1524-4725.2008.34378.x

References:

{1} Kamath, Preetha, Evan Darwin, Harleen Arora, and Keyvan Nouri. "A review on imiquimod therapy and discussion on optimal management of basal cell carcinomas." Clinical drug investigation 38, no. 10 (2018): 883-899. doi.org/10.1007/s40261-018-0681-x