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

1. Introduction and Clinical Significance

Basal cell carcinoma is the most common cutaneous malignancy worldwide [1]. Surgical excision provides the highest cure rates and remains the preferred treatment modality, particularly for facial lesions requiring margin control and tissue preservation [2]. Nevertheless, a subset of patients may refuse surgical procedures due to comorbidities, fear, or cosmetic concerns. Non-surgical treatment modalities, including cryotherapy and topical immunomodulatory agents, have been utilized in selected cases [3]. Imiquimod stimulates local immune-mediated tumor destruction, while cryotherapy induces direct cellular necrosis [4,5].

Clinical Significance:

This case demonstrates that combined non-surgical therapy may achieve complete clinical resolution in a high-risk facial lesion when surgery is declined, highlighting the importance of individualized management and careful surveillance.

2. Case Presentation

A 60-year-old male presented with a progressive ulcerative lesion at the junction between the left nasal wall and lower eyelid (Figure 1). The lesion demonstrated raised pearly margins and central necrosis, features strongly suggestive of nodulo-ulcerative basal cell carcinoma [1].

The patient had uncontrolled hypertension and type 2 diabetes mellitus. He declined biopsy and all surgical interventions despite repeated counseling.

2.1. Treatment Protocol

Cryotherapy was administered every two weeks using two freeze–thaw cycles of four seconds each, including a 2-mm clinical margin [4]. Imiquimod 5% cream was applied three times per week between sessions [5].

Local inflammatory reactions such as burning, itching, and crusting were observed, consistent with known imiquimod adverse effects [6]. These were managed with temporary interruption and emollient therapy. Fusidic acid ointment was applied for five days post-cryotherapy to reduce infection risk.

2.2. Outcome

Significant improvement was observed by the second month (Figure 2). Complete healing occurred after five months with residual scar formation (Figure 3). No recurrence was detected during one year of follow-up.

Ethical review and approval were waived for this study due to its single-patient case-report nature. Written informed consent was obtained from the patient for publication.

3. Discussion

Basal cell carcinoma remains the most common skin malignancy worldwide [1]. Surgical excision, particularly Mohs surgery, provides optimal cure rates for facial lesions [2]. However, non-surgical management may be considered when surgery is refused.

Although histologic confirmation was not obtained, the classical clinical presentation strongly supported the diagnosis [3]. The combination of cryotherapy and imiquimod may enhance tumor clearance by combining direct cellular destruction with immune-mediated mechanisms [4,5].

Recurrence patterns vary according to tumor characteristics and treatment modality [7]. Therefore, long-term follow-up remains critical, particularly in high-risk facial lesions.

4. Conclusions

This case supports the potential role of combined cryotherapy and topical imiquimod as an alternative treatment in carefully selected patients refusing surgery. While surgical excision remains the gold standard, individualized treatment strategies may be appropriate in selected scenarios. Continuous surveillance is mandatory to detect possible recurrence.