Abstract Listings 2026

Purpose

This review evaluated the clinical and histopathological efficacy, safety, and cosmetic outcomes of 5% imiquimod (IMQ) cream used alone or in combination for superficial and nodular periocular basal cell carcinoma (BCC).

Methods

A systematic search of MEDLINE, PubMed, and Google Scholar (inception–June 12, 2025) identified studies on IMQ for eyelid/periocular BCC. Randomized, non-randomized, and observational studies were included. Risk of bias was assessed using Cochrane RoB 2 and ROBINS-I; certainty of evidence was graded with GRADE.

Results

Seven studies (152 lesions) were included. The pooled clinical and histological clearance rate was 82% (95% CI: 72–90%). In the only randomized trial (n=27), both IMQ and radiotherapy achieved 100% histological clearance at 3 months, with superior cosmetic outcomes in the IMQ group. Combination therapy (IMQ + cryotherapy) showed 87.5% sustained remission at up to 5 years. Local adverse effects (erythema, crusting, conjunctivitis) occurred in ≥70% of cases but were mild-to-moderate and self-limiting; no systemic events were reported. A safety cohort (47 patients) showed only transient ocular irritation. Evidence certainty was moderate for short-term efficacy and low for long-term outcomes.

Conclusion

IMQ 5% is an effective, tissue-sparing option for selected periocular BCC, particularly when surgery is contraindicated or cosmetic outcomes are critical. Clearance rates are slightly lower than Mohs surgery but comparable to radiotherapy, with better cosmetic results. Larger RCTs with ≥3-year follow-up are needed.

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