Basal Cell Carcinomas Treated With Ablative Fractional Laser and Ingenol Mebutate

Patients will receive ablative fractional laser (AFXl)-assisted ingenol mebutate (IM) as a treatment for their cutaneous basal cell carcinoma (BCC). Treatment areas consisting of tumors and a 5 mm margin will undergo AFXl exposure (CO2 laser) followed by IM 0.015% or 0.05% under occlusion for 2-3 days. .

local skin reactions are monitored at baseline (day1), day 3/4, day 8, day 15, day 29, day 90, and tumor response monitored at baseline, day 29, and day 90. An additional repeat AFXl-IM treatment on day 29 will be offered if tumors persist, based on clinical evaluation and imaging on day 30.

Primary outcome:

• severity and duration of clinical local skin reactions including erythema, scaling, edema, blistering, erosion/ulceration and crusting using a 0-4-point scale at all visits from baseline to day 90.
• To monitor BCC tumor response on clinical assessments supported by non-invasive imaging techniques including optical coherence tomography (OCT) and reflectance confocal microscopy (RCM) at baseline, day 29 and day 90.

Inclusion criteria

Subjects who meet all of the following criteria are eligible to participate in this study

• Patients with histologically verified, low-risk, previously untreated superficial or nodular BCCs on the scalp, face, extremities or trunk
• > 18 years of age at baseline
• Legally competent, able to give verbal and written consent
• Communicate in Danish verbally as well as in writing
• Subject in good general health, is willing to participate and able to give informed consent, and can comply with protocol requirements.
• Fitzpatrick skin phototype I-III
• Female subjects of childbearing potential must be confirmed not pregnant by a negative urine pregnancy test prior to trial treatment.

Exclusion criteria

Subjects meeting any one of the following criteria are not eligible to participate in this study

• Patients with

o High-risk BCC

• Tumors on the following anatomical locations:

• Midface region
• Orbital areas
• Ears
• ii. Size:
• > 20 mm in facial/scalp areas
• > 50 mm in non-facial/non-scalp areas

• Subtype:
• Morpheaform
• Medical history
• Gorlin syndrome

o Immunosuppressive medication

• Subjects with a known allergy to IM.
• Individuals with other skin diseases in the area of research interest
• Subjects with tattoo in the treatment area which may interfere with or confound evaluation of the study
• Subjects with a history of keloids which is deemed clinically relevant in the opinion of the investigator
• Subjects with Fitzpatrick skin phototype IV-VI
• Lactating or pregnant women