Case Study: Non-Invasive Combo Therapy Resolves Nodular BCC

A combination of cryotherapy, 5-fluorouracil, and imiquimod achieved clinical resolution of a large nodular basal cell carcinoma (nBCC) in the inguinal region, according to a recent case report in the Journal of Clinical and Aesthetic Dermatology.

The case featured a 72-year-old woman presented with a 3.5 x 2.0cm nBCC in the anterior thigh and groin. Surgical excision was initially recommended due to the lesion's size, nodularity, and high-movement location. However, concerns about wound closure, need for grafting, and the risks of general anesthesia led the patient to opt for a less invasive approach.

The clinicians started with one session of liquid nitrogen cryotherapy (two 60-second freeze cycles with 90-second thaw). The patient then applied topical 5% 5-fluorouracil (5-FU) twice daily for 4 weeks, followed by 5% imiquimod cream three times weekly for 12 weeks. The lesion resolved by day 156 with no signs of residual malignancy.

“This case represents the successful treatment of nodular BCC with combination topical therapy that otherwise required surgical intervention,” the authors wrote. Cryotherapy was used to disrupt cell membranes and release tumor antigens, while 5-FU and imiquimod provided cytotoxic and immune-stimulatory effects, respectively.

The authors explained that while 5-FU and imiquimod are established for superficial BCC, clearance rates for nodular subtypes were more varied, but noted that in this case, combo therapy avoided surgery.

“Topical therapy may be a viable alternative to surgery for certain nodular BCCs, particularly for patients at higher risk for surgical complications,” the authors wrote. “This approach could reduce the need for invasive procedures, minimize recovery time, and avoid the risks associated with general anesthesia and surgery.”

Source: Al-Tariq K, et al. J Clin Aesthet Dermatol. 2025;18(8):18–19.