Non-surgical Management of Ulcerative Facial Basal Cell Carcinoma Using Cryotherapy and Topical Imiquimod: A Case Report

Abstract

Background and clinical significance: Basal Cell Carcinoma (BCC) is the most common malignant tumor of the skin and represents the majority of non-melanoma skin cancers, particularly affecting sun-exposed facial areas. Surgical excision remains the gold standard due to high cure rates, especially for high-risk facial lesions. However, patient refusal of biopsy or surgery may create therapeutic challenges. This case highlights a non-surgical alternative approach and emphasizes its clinical implications.

Case presentation: A 60-year-old Egyptian man with uncontrolled hypertension and type 2 diabetes mellitus presented with an ulcerative lesion located between the left nasal wall and lower eyelid. Clinical examination revealed raised pearly borders and central necrosis, highly suggestive of nodulo-ulcerative basal cell carcinoma. The patient refused biopsy and surgical intervention despite counseling and referral for Mohs micrographic surgery. A non-surgical regimen was initiated consisting of cryotherapy every two weeks using two freeze–thaw cycles of four seconds each with a 2-mm margin, combined with topical imiquimod 5% cream applied three times weekly. Episodic local inflammatory reactions occurred and were managed conservatively with temporary interruption and emollient therapy. Fusidic acid ointment was applied post-cryotherapy. Complete clinical resolution was achieved after five months with residual scarring and no recurrence during one year of follow-up.

Conclusion: Combined cryotherapy and topical imiquimod may represent a viable therapeutic alternative in carefully selected patients refusing surgical management. Close monitoring and long-term follow-up remain essential.