Imoquimod and Fluorouracil creams are topical agents approved by the US Food and Drug Administration (FDA) to treat superficial basal cell carcinoma (BCC). According to anecdotal reports, they have also been used to treat other cutaneous malignant neoplasms. Imiquimod is an immunomodulator that functions as a toll-like receptor 7 and/or 8 agonist and induces a type 2 helper T cell cytokine cascade. The resultant activation of cytotoxic T cells leads to the destruction of virus-infected host cells and tumor cells. Fluorouracil is a fluorinated pyrimidine antimetabolite that inhibits DNA synthesis.1 Although studies have been performed to determine the efficacy of these 2 medications as topical treatments for BCC and squamous cell carcinoma (SCC), it is difficult to ascertain their definite clearance rates owing to the lack of randomized controlled studies with long term follow-up.

Evidence supports the use of topical Imiquimod as monotherapy for superficial BCC and topical Fluorouracil as monotherapy for superficial BCC and SCC in situ. We recommend that their use be limited to patients with small tumors in low-risk locations who will not or cannot undergo treatment with better-established therapies for which long term clearance rates have been determined. Long-term clinical follow-up is essential for patients treated with topical Imiquimod or Fluorouracil. Limitations of therapy include high rates of adverse effects, lower clearance rates than other treatment modalities, dependence on patient adherence to treatment, and higher costs than other therapies.

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