Author’s Disclosure Block: Ryan Eidsness, none; Seyedeh Zahra (Mona) Moossavi, none; Alexa Materi, none

Abstract Body
Purpose: The Purpose: of this study is to present my experience with the use of topical Imiquimod 5% for periocular BCC. BCC makes up >90% of all periocular malignancies. Non-surgical management of tumors are becoming increasingly important. Some patients are not surgical candidates while others prefer a non-surgical option. This study aimed to find if a reduced frequency treatment protocol maintained efficacy while increasing tolerability.Design: A retrospective case series of a single Oculoplastic specialist practice.Method: A chart review of patients that were treated with Imiquimod 5% for periocular tumors between 2008 and 2024. Patients were treated with 5% imiquimod 3 days per week (M-W-F) for four weeks and then reevaluated at a 6 week time period. A second 4 week regime was used in some patients. To decrease the risk of ocular side effects, erythromycin ointment was placed in the inferior cul-de-sac prior to the imiquimod being placed on the skin. Follow up was performed for >1 year in all patients. Results: A total of 12 patients were included in our study. All BCC were on the lower eyelid (8) or medial canthus (4). Six patients required 1 four week course and 6 patients required 2 four week courses. Only 2 patients discontinued treatment due to side effects of the medication and went on to successful surgery. Eight out of the 10 patients had complete response with no signs of recurrence with follow up ranging from 12 months to 8 years. There were two other patients that were too frail for surgery and used Imiquimod as a palliative treatment. They responded well to the treatment, but did not completely resolve Conclusion: BCC is the most common periocular cancer making up 90% of cancers. Surgery is the gold standard of treatment, but can cause damage to key structures like the lacrimal drainage system. In addition, some patients are not surgical candidates due to comorbit conditions. We present our experience of 12 patients with BCC treated with a less aggressive Imiquimod 5% treatment course. 10/12 patients completed the treatment course and all that did had a favorable response. We feel that Imiquimod is a alternative to surgery that should be presented to patients.