In-vivo diagnosis and non-inasive monitoring of imiquimod 5% cream for non-melanoma skin cancer using confocal laser scanning microscopy

Basal cell carcinoma (BCC) is the most common cutaneous malignancy with increasing incidence rates worldwide. A number of established treatments are available, including surgical excision. The emergence of new non-invasive treatment modalities has prompted the developemtn of non-invasive optical devices for therapeutic monitoring and evaluating treatment efficacy. This study was aimed to evalutate the clinical applicability of a fluorescence confocal laser scanning microscope (CFLSM) for non-invasive therapeutic monitoring of basal cell carcinoma treated with Imiquimod (Aldara (R)) as topical immune-response modifier. Eight participants with a diagnosis of basal cell carcinoma (BCC) were enrolled in this investigation. Sequential evaluation during treatment with Imiquimod showed progressive normalization of the confocal histomorphologic parametes in correlation with normal skin. Confocal laser scanning microscopy was able to identiffy characteristic features of BCC and allowed the visualization of therapeutic effects over time. Thus our results indicate the clinical applicability of CFLSM imaging to evaluate treatment efficacy in vivo and non-invasively. CELSM images obtained after three weeks of Imiquimod illustrating demarcaion of corneocytes, and the presence of parakeratotic nuclei.