What to Know About Aldara Cream (Imiquimod) for Basal Cell Carcinoma

Good sunscreen protection is always a good idea (even if you have darker skin) to help prevent skin cancer. In the U.S., basal and squamous cell carcinomas (types of skin cancer) are the most common types of cancer. And about 80% of skin cancer cases are basal cell carcinomas. 

Basal cell carcinoma can be very common, but it’s also very treatable when caught early. Along with surgery and radiation, local treatments like Aldara can be used. Read on to learn more about Aldara and how it works for basal cell carcinoma.

What is Aldara?

Aldara is topical imiquimod cream that’s applied directly to the skin. When applied topically, imiquimod is thought to activate your immune system in the skin to treat certain precancerous and cancerous skin conditions, as well as genital warts. But it’s not clear exactly how it works.

How does Aldara cream work for basal cell carcinoma?

Since Aldara is a topical treatment, it’s put directly onto the skin where it can be absorbed and reach the basal cell cancer. By activating immune cells, Aldara helps target and kill cancer cells in the skin.

When basal cell carcinomas are only at the surface of the skin and haven’t spread or grown deep, they’re considered superficial. Aldara can be used for superficial basal cell carcinoma if a tumor lesion is small and only in certain areas of the body (like your torso, arms, or legs). It’s also typically reserved for people who can’t have surgery.

How is Aldara given when treating basal cell carcinoma?

When used to treat superficial basal cell carcinoma, a thin layer of Aldara 5% cream is applied to the affected area five times a week (e.g., Monday through Friday). It’s available as single-use packets, so you’ll use one packet per application.

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A thin layer is applied to the tumor, along with a small margin around it. The cream should be rubbed into the treatment area until it’s no longer visible. Wash your hands well before and after applying it.

Aldara is usually applied before bedtime. It should be left on the skin for about 8 hours. After the 8 hours are up, the skin is washed with a mild soap and water.

Treatment is usually continued for 6 weeks, but your provider may adjust that depending on how your skin is responding. And your skin may take up to 12 weeks to fully heal after treatment.

When storing Aldara at home, make sure to keep it away from children and pets. It’s also a good idea to separate it from other creams and lotions.

What are the potential side effects of Aldara?

Since Aldara is applied topically, most side effects are local. This means that they happen only where it’s applied.

Common Aldara side effects

Aldara can cause different types of skin irritation wherever it’s applied. The most common local skin and application site reactions include:

• Erythema (redness)

• Flaking, scaling

• Hardening of the skin

• Scabbing, crusting

• Swelling

• Erosion or deep scarring

• Ulceration

• Blisters

• Itching

• Burning

You’ll also want to protect your skin when under the sun. This is especially important while using Aldara. That’s because it can make your skin very sensitive to the sun. Make sure to avoid direct sunlight as much as possible, and wear sunscreen and protective clothing.

Serious Aldara side effects

Any of the common side effects could be severe. Some serious cases of ulcers and skin draining (weeping) have been reported. Treatment site infections have also occurred, but they are rare. In these cases, skin was allowed to rest and was treated with antibiotics.

What are some alternative treatments for basal cell carcinoma?

Surgery is the preferred treatment method for basal cell carcinoma. But it may not be an option for everyone. Your dermatologist will determine if a topical treatment is a good option for you. Besides Aldara, other treatments that can be used topically include:

• Topical fluorouracil. Efudex is a topical form of fluorouracil that’s available as a cream or solution. It’s a type of chemotherapy applied to the skin. Like Aldara, it can cause skin irritation where it’s applied.

• Cryosurgery. This treatment freezes a tumor with liquid nitrogen. This kills the cancer cells. The skin thaws and blisters, and will heal after it peels. This treatment can also leave a scar.

• Photodynamic therapy (PDT). First, a gel or liquid medication is applied to the skin. Next, a light source activates it. The activated medication then kills cancer cells in that area. PDT tends to leave less scars.

After 5 years of follow up, one study comparing Aldara, PDT, and topical fluorouracil found that Aldara worked better than both other treatments. 

How to save on Aldara

Aldara is available as a brand-name and generic medication. If you don’t have insurance, or if your copay is still high, GoodRx can help you save on your prescription. You can find generic Aldara (imiquimod) for as low as $29.86 at certain pharmacies with a free GoodRx discount.

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Written by:

Emmeline C. Academia, PharmD, BCOP

Emmeline C. Academia, PharmD, BCOP, has been a practicing clinical pharmacist in adult oncology since 2020. She is a clinical pharmacy specialist in oncology at Beth Israel Deaconess Medical Center, in Boston.

Edited by:

Alyssa Billingsley, PharmD

Alyssa Billingsley, PharmD, is the director of pharmacy content for GoodRx. She has over a decade of experience as a pharmacist and has worked in clinical, academic, and administrative roles.

Reviewed by:

Maria Robinson, MD, MBA

Maria Robinson, MD, MBA, is a board-certified dermatologist and dermatopathologist who has practiced dermatology and dermatopathology for over 10 years across private practice, academic, and telehealth settings. She is a fellow of the American Academy of Dermatology and the American Society of Dermatopathology.

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