Latest news with #Imiquimod
Newsweek
06-07-2025
- Health
- Newsweek
Woman, 33, Has Small Pimple for Two Years, Then Comes Shock Diagnosis
Based on facts, either observed and verified firsthand by the reporter, or reported and verified from knowledgeable sources. Newsweek AI is in beta. Translations may contain inaccuracies—please refer to the original content. When Rachel Archer noticed a small pimple on her forehead, she thought nothing of it—having acne-prone skin, she was used to it. But when it didn't disappear and started to bleed six months ago, she began to worry. The 33-year-old, who lives in North Carolina, sought medical advice and was initially told she was too young for cancer, sent away with the theory that it was a scratched mosquito bite. The next month, she returned to the doctor and was sent for a biopsy. Archer was diagnosed with the most common type of skin cancer, called basal cell carcinoma (BCC), often caused by sun exposure. The American Cancer Society (ACS) states roughly 5.4 million basal and squamous cell skin cancers diagnosed each year in the U.S. After posting her journey online @racheltemac, she told Newsweek: "When you are younger you don't think about the risks of being in the sun too long and getting sun burnt so I believe seeing a video of what it would be like to get skin cancer would be helpful for younger people, so they are more careful! "I think it's good for people to see that you can get skin cancer even at a younger age and you need to be careful, or you could get skin cancer too!" (L-R) Archer before the diagnosis and a close up of the pimple on her forehead. (L-R) Archer before the diagnosis and a close up of the pimple on her forehead. TikTok/@racheltemac Speaking about her own relationship with the sun, the mom of three explained that she only started using sunscreen in her late twenties. She also used tanning beds a handful of times. With no family history of cancer, Archer described the diagnosis as "surreal." "Especially at my age," she said. In a TikTok clip shared on June 15, Archer can be seen with a large round scab on her forehead. This is from six weeks of a chemotherapy topical solution called Imiquimod. The ACS states it is a prescription cream that you can put on during very early-stage skin cancers (like some basal cell cancers). It works by triggering your body's immune system to attack and get rid of the abnormal skin cells. You usually put it on the affected area several times a week for a few weeks, but exactly how often depends on your doctor's instructions. "It was applied multiple times a week for six weeks," explained Archer. "The treatment caused my skin to react by bleeding and scabbing up. It felt like my skin was being burned off and it's possible that is what was happening." Today, she never leaves the house without Sun Protection Factor (SPF), and encourages others to do the same. In the clip, which has 1.2 million views, she says: "There's no excuses to lay out and get burned" with the number of products that contain sunscreen that are now available. What Are the Warning Signs of Skin Cancer? Newsweek spoke to Dr. Hannah Kopelman, a dermatologist clinically trained in cutaneous oncology at Boston University and in hair loss at Columbia University. She said: "Skin cancer doesn't always look dramatic or obvious. It can start as something that seems harmless—a tiny pimple that doesn't heal, a rough patch that keeps coming back, or a mole that slowly changes over time." She explained the key signs to look for are referred to as ABCDEs of melanoma: Asymmetry Irregular borders Color variation Diameter larger than a pencil eraser, and evolution or change. She added: "But even beyond that, any lesion that bleeds, crusts, itches, or lingers longer than a month without healing is worth getting checked. Trust your instincts—if something feels off, it's always better to get it evaluated." If a spot doesn't heal within four to six weeks, Kopelman, who practices in New York at Kopelman Aesthetic Surgery, encourages people to sought medical advice. (L-R) Archer was left with a large scab on her forehead following chemotherapy. (L-R) Archer was left with a large scab on her forehead following chemotherapy. Rachel Archer Advice for People Who Are Dismissed Because of Their Age Kopelman told Newsweek: "This part really hits home for me because I've had young patients come in after being told they're 'too young' for skin cancer. I want to be very clear: skin cancer does not discriminate by age. I've diagnosed aggressive forms of melanoma in patients in their 20s and even late teens. If you feel like your concerns are being brushed off, please don't give up. "You have every right to advocate for your health. Seek a second opinion—preferably with a board-certified dermatologist—and keep pushing until you're heard. You know your body better than anyone, and early detection saves lives." Is there a health issue that's worrying you? Let us know via health@ We can ask experts for advice, and your story could be featured on Newsweek.
Medscape
30-06-2025
- Health
- Medscape
Real-World Cases of Skin Cancer Management in Older Adults
Supporting Data and the Patient's Response to Imiquimod Supporting that decision-making process was a randomized controlled trial published in 2017 comparing surgery with imiquimod 5% cream for nodular and superficial BCC, showing that imiquimod was inferior to surgery but still provided sustained benefit, Patel said. The 5-year success rates (absence of recurrence) in that trial were 82.5% compared with 97.7% for surgery (relative risk of imiquimod success, 0.84; 95% CI, 0.77-0.91; P < .001) — rates that were comparable to previously reported 3-year success rates of 83.6% and 98.4% for imiquimod and surgery, respectively. Most recurrences occurred within the first year. The 'caveat,' Patel said, was that the trial looked only at low-risk locations such as the cheek and the trunk, and not the tip of the nose. Patients with superficial BCC received 6 weeks of imiquimod cream once daily, and those with nodular BCC received 12 weeks. Use of this therapy 'requires clear explanation to the patient and an understanding of the off-label and not-fully-evaluated potential application,' Patel said in an interview after the meeting. After 6 weeks of treatment, the patient had notable crusting of the nasal tip with surrounding erythema. At 12 weeks, the tip of her nose was 'smooth with no obvious residual carcinoma notable,' Patal said at the meeting. 'She tolerated the treatment well and had a great response.' There have been suggestions made among some Mohs surgeons that the Mohs surgery AUC for primary superficial BCCs should be reevaluated, Patel said, referring to a Viewpoint piece published in JAMA Dermatology in July 2018 that pointed out that they are indolent, penetrate minimally, and are often multifocal, making them amenable to nonsurgical treatments. The lower-risk nodular BCC subtype is also worthy of AUC reevaluation, he said. Decision-Making About a Second Lesion: Melanoma In Situ (MIS) During the follow-up period, the patient's daughter noticed a large 2 cm pigmented area on her mother's wrist, and a biopsy revealed MIS. NCCN guidelines for MIS recommend surgical excision with margins of 0.5-1 cm but contain a footnote that consideration of topical immunotherapy or radiation therapy is an option in select patients with MIS of the lentigo maligna (LM) subtype, Patel said. He pointed to a retrospective review published 10 years ago looking at 63 MIS/LM cases in which imiquimod 5% cream was used as either primary or adjuvant therapy. When used as primary therapy, with no surgery, 72.7% demonstrated clinical clearance at a mean follow-up of 39.7 (range, 8-95) months. And when used as adjuvant therapy, 94.4% demonstrated clearance at a mean follow-up of 43.1 (range, 4-106) months. One could opt for primary therapy, knowing that 3 out of 4 patients might have clearance lasting over the course of several-plus years. Or, in the case of adjuvant therapy, 'you could do a partial resection or narrow margin resection, and if you have positive margins, go back and have an even higher success rate with adjuvant imiquimod cream,' Patel said. For his 88-year-old patient, 'surgery for a 2 cm tumor on the wrist, with skin that's fragile, is not easy to accomplish, certainly not easy to close up,' he said. The question was, 'could we cause more harm than good?' The patient decided on every-other-day treatment with 5% imiquimod cream for 6 weeks and responded with some clearing. She continued for another 6 weeks but on follow-up was noted to have some areas of progression. 'She ultimately needed an excision as the lesion was progressing in one area, and rebiopsy showed minimal invasion of the MIS, but she was now happy to do so as she felt it was necessary and declared by the disease,' Patel said after the meeting. She was able to undergo an excision with clear margins, and a complex layered closure with a partial skin graft was performed, which she tolerated well. A Patient With SCC In Situ (SCCis) Another patient recently referred to Patel for discussion of Mohs surgery was an 89-year-old man who had multiple rough, scaly patches on his bald scalp, a history of prostate cancer, hypertension managed with hydrochlorothiazide, and no family history of melanoma or keratinocyte carcinomas. Biopsies on two areas of the scalp vertex within 1 cm of each other and one on the neck revealed an SCC in situ on the scalp with an adjacent actinic keratosis (AK). In addition, a biopsy on the neck revealed 'AK with focal SCCis,' Patel said at the meeting. 'We'd agree this patient does not need Mohs. But [in this case] we posed a question that was [examined] in a recent study: Does SCC in situ need treatment at all?' Patel said, referring to a single-center cohort study published in 2024 in which 411 consecutive SCCis tumors with a clinically resolved biopsy site were managed with watchful waiting. Of the 411 tumors, 17 recurred locally (4% recurrence rate), and there were no instances of nodal metastases, distant metastases, or disease-specific death. The highest risk for local recurrence was conferred by a history of solid-organ transplantation (hazard ratio [HR], 9.979; 95% CI, 2.249-39.69), and additional risk factors predicting local recurrence were location of the tumor on the vermillion lip or ear (HR, 9.744; 95% CI, 1.420-69.28) and on the head and neck (HR, 6.687; 95% CI, 1.583-36.15). The size of the lesion was also predictive of recurrence, with biopsies showing tumor extension to the deep edge being associated with a sixfold increased risk (HR, 6.562; 95% CI, 1.367-39.04). 'In typical, run-of-the-mill smaller SCCis, the vast majority of these lesions after biopsy did not recur,' Patel said. Many experts have proposed the consideration of topical therapy as a first-line treatment for SCCis, but 'the question sometimes comes up of whether we can identify patients' at a higher risk for recurrence, he said. A study published this year of 5-fluorouracil (5-FU) 5% cream for SCCis found that shorter treatment duration (particularly under 2 weeks) and larger lesion size (> 2 cm) were associated with a higher risk for treatment failure. Beyond that, there was no [impact] of immunosuppression or anatomic location, including hair-bearing locations, on the risk of recurrence, Patel said. The patient decided to pursue 2 weeks of therapy with 5-FU to help mitigate potential side effects, Patel said after the meeting. 'He did well….and we decided to monitor after the shortened treatment course.' Is Intralesional Treatment Coming? In the future, intralesional treatment may make skin cancer therapy 'even easier' for older patients, Patel said at the meeting. In a case report published in 2024, a 98-year-old wheelchair-bound 80-pound woman with frailty — and a 3.5-cm rapidly growing crusted nodule on her left proximal-lateral arm was treated with intralesional 5-FU — weekly for 4 weeks — after a shave biopsy revealed an invasive, well-differentiated SCC. There was no sign of recurrence at 3 months, and the patient died 6 months later of primary cardiac arrest, Patel said, noting that this was a case 'of doing no harm and limiting the morbidity associated with this tumor rather than approaching it from an aggressive standpoint.' A phase 3 trial of intralesional cemiplimab in patients with early-stage cutaneous SCC, newly underway at GW and multiple other sites, will look at how well the immune checkpoint inhibitor works when injected into the lesion, compared with surgery. The goal is to provide cutting-edge immunotherapy while potentially avoiding systemic toxicity, thus making this a viable nonsurgical option for older patients or those with surgical fatigue, Patel said after the meeting. Patel disclosed that he had received consulting honoraria from Regeneron Pharmaceuticals, Sun Pharma, Almirall, and Palvella Therapeutics, as well as research support from Regeneron Pharmaceuticals. He had served on the speaker's bureau with Regeneron Pharmaceuticals, Sun Pharma, and Almirall, and was the cofounder of the Skin Cancer Outcomes Consortium. Lead image: Moment/Getty Images Image 1: GWU Department of Dermatology
