This is a topically applied drug which works by stimulating the body’s own immune system to destroy cancer cells. It was actually first used in the treatment of genital warts.
When can Aldara be used?
It is suitable for the treatment of actinic keratoses (pre cancers) and superficial skin cancers, notably superficial BCC and Bowen’s disease (SCC in situ)
How is it used?
There are various treatment regimes, but typically it is applied 5 times per week for 6 weeks for superficial skin cancer and 3 times per week for 4 weeks for actinic keratoses. However, there are variations on these regimes.
What happens after a course of treatment?
It results in a local reaction which may at times be severe. This takes the form of redness, scabbing and possibly blistering. There may also be a general reaction in which the patient feels like they have influenza. In about 5% of cases it fails to “switch on” the immune system and no reaction occurs.
The treated area will heal with some form of scar, usually leaving a slightly depressed a whitened area.
How effective is it?
This treatment is highly effective for the precancerous actinic keratoses, especially when used to treat in cases with numerous lesions. It is about 80% effective in the treatment of superficial skin cancers. It is 50-80% effective in the treatment of very superficial skin cancers.
It is more unpredictable than Efudix and reactions may be severe and can lead to ulceration and scarring. It may be associated with a “flu like” illness (especially when large areas area treated). It is for these reasons, that SPSSCC will typically recommend Efudix instead of Aldara.
Should it be used more often for skin cancers?
SPSSCC does not generally recommend its usage for the treatment of skin cancer as there are alternative treatments with much higher cure rates, with more than acceptable scarring and without the risk of severe local skin reaction and systemic side effects.
Does it have any disadvantages in the treatment of skin cancer?
Its main disadvantage is that it is often used inappropriately to treat thicker, invasive skin cancers, especially on the face. The recurrence rate in these scenarios are very high, and subsequent treatment is always more difficult and complicated.
Compared to other treatments, it has a relatively low cure rate, and can have severe reactions.